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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL PEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Colorado Division otHighways <br />~ M-1981-043 <br />N Of Douglas Pass <br />February 1, 2007 <br />$$281.00 (Due on or before your anniversary date) <br />Rio Blanco <br />~N 9 0 2007 <br />Dit~i-,on ofR~clamation, <br />/ii,iin9 and Sat'eiy <br />According to C.K.S, 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />_ _ operator shaD_sub_mit the annual fee, a report and map showing the_e~tent 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 map 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 chances 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 VASmo.V ~/~/TF.1f~ y~ <br />Permittee Name; Colorado Division of Highways CO~OrCi d 0 IJNDart U)Cn 1 0~ ir-Ct nS YJOr`~a +tOYI <br />Address: 222 S 6th St Rm 317 -~i <br />- - - Grand Junction; CO 81501---'--_ <br />Phone Number: ~ (970) 248-7228 X3'70) 2%8 - 723i n <br />Fax Number: ~~/'~ y~ ~ ~/ ~ - 7 ~ 9~ <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 />'-'-' Jar <br />Siglture of Corporate Officer, Owner, or Designee ~lo ~79TE'~CI/a~- Rtri~~oi/c1J /.V ~CxI eS <br />i-22- 07 <br />Date <br />M:IPERMITUrASTERD000MENTSU1-AF-04 <br />