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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 />t~Colorado Division of Highways <br />,/M-1979-155 <br />Dotsero Cinder Pit <br />February 1,2007 <br />Dig :aion of Reclamation, <br />Niini,~g and Safety <br />$$281.00 (Due on or before your anniversary date) <br />Eagle <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 />_operatorshall_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 since 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 \ JASr"le() , l ivy i r/-/ <br />Permittee Name: Colorado Division of Highways ~~ l Q[pYa ci'n ~eoot~'f men tb't" - <br />~ TransPo~+w+ion <br />Address: 222 S 6th St Rm 317 <br />-- Grand Junction, CO 81501 <br />Phone Number: (970) 248-7228 % 70 2 8 ' 7-2,~ <br />Fax Number: ~'7U) 2 ~g ~ ~ ~ 9 Z <br />-~-~ <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. `~7 <br />J ,,, v <br />Si~ure of Corporate Officer, Owner, or Designee /vo ma>EX~.4~ ~-~'~/Et~ IN 2~6 <br />i 22-07 <br />Date <br />M:~PERMITMASTERDOCUMEMSNI-AE-04 <br />