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iiiiiiiiiii . <br /> ANNUAL FEE and REPORT REQUEST <br /> RECEIVE® <br /> PERMITTEE NAME: E-470 Public Highway Authority <br /> AUG 2 4 201 <br /> PERMIT NO.: M-1980-110 <br /> OPERATION NAME: Henderson Development Division of Minerals and Geology <br /> ANNIVERSARY DATE: September 9,2001 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: Adams <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator <br /> shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br /> during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br /> of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearl- delineates and includes the above elements may since for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: D. Michael Callis <br /> Permittee Name: E-470 Public Highway Authority <br /> Address: 22470 E. 6th Pkwy <br /> Aurora, CO 80018 <br /> Phone Number: (303) 537-3470 <br /> Fax Number: <br /> If you have additional comments and/or information that should be provided to the Division, please provide it <br /> below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br /> Signature of Corporate Officer or Owner <br /> Date <br /> M:TERM ITMASTERDOCUM ENTSW AF01 <br />