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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 />E-470 Public Highway Authority <br />M-1980-110 <br />Henderson Development <br />September 9, 2007 <br />$$791.00 (Due on.or before.your_anniversary date)_ <br />Adams <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamafion accomplished to date and during the preceding year, new disturbances that are anficipated to occur <br />-during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of acfive operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report mau to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />ma If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the urevious year's mau are necessary, then no new map is required. provided that the Ouerator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following pernuttee contact information. Please verify and make any necessary <br />changes: <br />Pernrittee Contact: ' Matt Alexander <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: (303) 537-3472 <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. Annua] Report instructions are enclosed. <br />ignature of Corporate Officer, Owner, or Designee <br />~5~° <br />Date ' <br />