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MftR-R5-2004 13:41 FROM:CDOT MATERIALS LR8 303-757-9008 70:9702487292 P.011~017 <br />ANNUAL FEE and REPOR, REQUEST RECEIVED <br />PERMITTEE NAME: Colorado Divlslon of Fighways MAR 31 2004 <br />PERMfT NO,: M-1981-043 Division of Minerals & Ceolopy <br />OPERATION NAME: N Of Aonglas Pass <br />ANNIVERSARY DATP.: February 1, 2004 <br />ANNUAL FEE DUG; $281.00 (Doe on or before ,your anniversary date) <br />COUNTY: Rio Blanco <br />According to C.R.S. 34-32.5-J.1G or C.R.S. 34-32.1.16, each year, on the anniversary date of the permit, an <br />opczator shall submit the attttual fee, a report and map showing the extent of current disturbances to affected <br />land, recfeination accomplished to date and during the preceding year, new disturbances that are antieipatcd tv <br />occur during the upcoming year, rec]amation that will be performed during the coming year, the dates far the <br />beginning of active operations, and the date active operations ceased for the year, if arty. <br />Please attaeh hoar revised written anmtal report and annual reoart. mau to this form. Please nose that an <br />adequately labeled map that clearly delineates and include the above elentenrs may since for a written report. <br />Division records indicate the following petmittee contact information, Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Pricvc <br />Pernu,ttee Name: Colorado Division of Highways <br />Address: 4340 E. Louisiana Ave. <br />Denver. CO 80222 <br />Phone N~>rnbet: (303) 757-9269 <br />Fax Number: <br />If you have additional comments andlor information that should he provided to the Division, please provide it <br />below or atmch it to this form along with your written report and map. Annual Report inshuctions ate enclosed. <br />Signature of Corporate Oilicer or Owner 1 '7Lf ~ ~ N S ACS 0 J~ <br />3- Z y-a~ <br />Date ;~ Zbo3 <br />