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5 <br />.~~~~ <br />PERM[TTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />I/ ANNIJAL FEE and REPORT REQUEST <br />~/E-470 Public Highway Authority <br />I/ M-1980-110 <br />Henderson Development <br />September 9, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Adams <br />RECE~~~ p <br />~ AUG 3 p ?006 <br />vision of Recla <br />Mining and Samation, <br />ety <br />According to C.R.S. 34-32.5-1 16 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 />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />maa (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />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: Matt Alexander <br />Permittee Name: E-470 Public Highway Authority <br />Address: <br />Phone Number: <br />Fax Number: <br />22470 E. 6th Pkwy. <br />Aurora, CO 80018 <br />(303) 537-3470 <br />(303)537-3472 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />Sinngnature of Corporate O ~cer, Owner, or Designee <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />