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JJ:•23-04 1040 FRCN-Col c. ado Jlvicion of Ainorile & Gtoloaf •13038883S8i <br />r• <br />A~iNi~Aj_ F'F:F. and RF,PAR'J' RF~_i F.fiT <br />PERMITTEE NAME: ITEC Environmental Colorado, Ina <br />PERMIT NO.: M-1994117 <br />OPERATION NAME: Gold Hil] Mill <br />.4NNiV6RSARY DATE: Tuly 26, 2004 <br />T-240 P.0021002 F-223 <br />ANNUAL FEE DUE: $225.00 (Due oa or before your amlversaty date) <br />COUNTY: Boulder <br />According to C.RS. 3432.5-11b or C It.S. 3~-32-11b, each year, on the anniversary date of the ;~emtit, an <br />operator shall submit the annual fee, 3 report and map showing the extent of current disturbances t u affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are ant':cipated to <br />occur during, the upcoming year, reclamation that will be performed during the coming year, the dares for the <br />beginning of active operations, and the date active operations ceased 1nr the year, if any. <br />Please attnch irons revised writf n ennnal r~trf and ann gal report m ~ m shin form. Please n~~te !hat an <br />adequately labeled map that c/early delineates and includes the above elements may suffice for a written <br />segos!. <br />Division records indicate the following peratittec contact information- Please verify and make any necessary <br />chattges: <br />Permittee Contact: Mark A. Steen <br />Perrrtitcee Nerve: ITEC Environmental Colorado, Inc. <br />Address: P.O. Box 1523 <br />Longmont, CO 80502 <br />Phone Number: (303) 651-2985 <br />Fax Number: (303)449-5352 <br />If you have additional cotttmems andlor information that should be provided to the Division, please provide it <br />below or attach it to this form along with yotu written repots and map. Annual Report irtstn ctions axe <br />enclosed. <br />~~ ~ <br />Signature of Corporate Officer, Owner, or Designee <br />~{' <br />a <br />M:WERblr!~MNarERDC1CUV£~V a S/M-M-02. W C <br />