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.,- ~, <br />PERMITTEE NAME: <br />PERMTT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Division of Highways <br />M-1979-142 <br />West of Maybell Pit <br />February 1, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Moffat <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 />--- -- - - -operator-shall- submit-the-annual-fe~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 ym~r revised written annnal report and annnal rep n~ rt m,1p to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Prieve <br />Permittee Name: Colorado Division of Highways <br />Address: 4340 E. Louisiana Ave. <br />Denver, CO 80222 <br />Phone Number: (303) 757-9269 <br />Fax Number: <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. <br />~0~ G o ~' fL. ~ ~ C' ~ C+.~ dQ~ <br />Signature of Corporate Officer, Owner, or Designee <br />z -3 -G~ <br />Date <br />M:IPERMI1wIASTEADOCUMENTSU1-AF-04 <br />