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?IRR-5~-2004 13:38 FRDM: CDDT MRTERIRLS LRB <br />PERM]TTEE NAME: <br />PERMTf NO.: <br />OPERATION NAMG: <br />ANNIVERSARY DATE: <br />ANNUAL PEE DUE: <br />COUNTX: <br />303-757-9008 <br />TD: 9702487292 <br />pNN[1AL FEPs and REPORT REOLT,E9T <br />Colorado uivision of Highways <br />lYI-1979-348 <br />A'lyrin Pit <br />February 1, 2004 <br />$281.00 (Dne on ar before your anniversary dato) <br />Routt <br />P.007~017 <br />According to C.R.S, 34-32.5-116 nr C.R.S. 34-32-11G, each year, on the anniversary date of the permit, an. <br />operator sltall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accompfisbed to date and during the preceding year, new distrbances that arc anticipated to <br />occur during the upcoming year, reclamati,an that will. be performed during the comittg year, the dates fox the <br />beginning of active operations, and the date active operations ceased fox the year, if any. <br />Please attach vour revised written annual rework and annosl report moo to tbis form. Please Wore that an <br />adequately labeled map that clearly dedineates and includes t)te shove efemenGs may since jot a written report. <br />Division records indicate the following pctmittee contact information. Please verify and males any necessary <br />changes: <br />Pexmittee ~ontact: Eric Prieve <br />Pcrmittee Name: Colorado Division of Highways <br />Address; 4340 E. Louisiana Ave. <br />Denver, CO 80222 <br />Phone Number: <br />Pax Number; <br />(303)757-9209 <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 enclosed. <br />Siptatut of Corporate Officer or Owner <br />~- z q_ o ~i <br />Date <br />77s~ ~„ <br />Z ~ ~ ~3 . <br />repo vec~ <br />