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~' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />/C//olorado Division of Highways <br />PM-1979-148 <br />Myrin Pit <br />February 1, 2007 <br />~/ G~ f~^ e p ~l"°~ <br />SAN 3 Q 20Q <br />Divlslon o~R, , <br />~Yiining and SaOa(y °n, <br />$$281.00 (Due on or before your anniversary date} <br />Routt <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit,_an <br />-operator"shall'submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanties to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: -~ <br />Permittee Contact: Rex Goodrich (1 aso_il , _ ,,, , mar/ <br />PennitteeName: Colorado Division of Highways CO'bi"GC~y Dt>nQ/`~nL11~0~ ~~SPorTa+'on <br />Address: 222 S 6th St Rm 317 ~ <br />Grand Junction, CO 81501 <br />Phone Number: (970) 248-7228 / t' 970) 2Y8 -7239 <br />Fax Number: l Q~ 0) - ~ 4 `d - ~ ~ ~ ~- <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 <br />enclosed. ~/ <br />NV <br />Sign re of Corporate Officer, Owner, or Designee <br />/-22 -d'7 <br />Date <br />X85 ; o.vs ,eE,naEV i,u 2cz~ 6 <br />M:NERMITMASTERDOCUMEMSUr-AF-04 <br />