REP11130

• Permit No: M1981043
• IBM Index Class Name: Report
• Doc Date: 2/6/2006
• Doc Name: Annual Rpt
• From: Colorado Division of Highways
• To: DMG
• Permit Index Doc Type: Annual Reclamation Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Colorado Division of Highways
M-1981-043
N Of Douglas Pass
February 1, 2006
$281.00 (Due on or before your anniversary date)
Rlo Blanco
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-] 16, each year, on the anniversary date of the permit, an
operator shall submit the annual fee, a report and_map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attar~,yo .r revised written anm~al rennrt and annual rennrt man to this form. please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Eric Prieve
Permittee Name: Colorado Division of Highways
Address: 4340 E. Louisiana Ave.
Denver, CO 80222
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annua] Report instructions are
enclosed.
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Signature of Corporate Officer, Owner, or Designee
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Date
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