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~,. <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-1979-148 <br />Myrin Pit <br />February 1, 2006 <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 />_ . operato~shall_submit_the.annual_fee,_a_reportand map_showing.the.extent.of current disturbances 1o_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 y mn• revised written anneal report and anm~al report main to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Prieve <br />Permittee Name: Colorado Division of Highways <br />Address: 4340 E. Louisiana Ave. <br />Denver, CO 80222 <br />Phone Number: <br />Fax Number: <br />{303)757-9269 <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 />~~~ ~~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~ '~ - © E <br />Date <br />~ ~ Z~7s ..~,.s <br />~~ <br />M:~PERMITMASTERDOCUMENTSIM-AF-04 <br />