Laserfiche WebLink
ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Division of Highways <br />/M-1985-170 <br />BLM Burnt Shale Pit <br />February 1, 2007 <br />~ I (^ <br />SAN ~~ 0 2007 <br />Division of hcc;amaiion, <br />"•,~ring and Safeiy <br />$$281.00 (Due on or before your anniversary date) <br />Garfield <br />---- --_. According-to-C.R:S. 34-32:5-1-16-or-C.R:S..34-32-1-16,-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 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 <br />Permittee Name: Colorado Division of Highways <br />n ~<isoAJ ~iTfl <br />1, l)IDYG t>'O nPt.~ r~"Men-{' o~ `~ransPorfa+~o'n <br />Address: 222 S 6th St Rm 317 <br />Grand Junction, CO 81501 <br />Phone Number: (970) 248-7228 JD .2 `fB - X2,-3 <br />Fax Number: ~ ~ ~ ~ ' ~ ~ 9 2 <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.///J ~~/ <br />/1~-.- ~~../il <br />Signatu a of Corporate Officer, Owner, or Designee ~ G~ 7onIS R~.movra /-~ 2CY~ <br />I-22 -D7 <br />Date <br />M:IPERMI'M4ASTERDOCUMENTSNI-AF-04 <br />