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c MRRr05-2004 13:42 FROM: CDOT MRTERIRLS LRB 303-757-9006 70:9702487292 <br />ANNfJAL FEE and REPORT REQ11>EST <br />P.013~017 <br /> <br />PERMITTEE NAME: Colorado Aivision of EGghway9 MAR 31 2004 <br />PERMIT NO.: 1N-1984-103 Oivisioa of Mlnerats & Geology <br />OPERATION NAME: Independence Pacs <br />ANNfVERSARX DATE: February ]., 2004 <br />ANNL3AL I:Efi DUE: $281.00 (Due on or before your anniversary date) <br />COTJNfX: Pitkin <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-11G, each year, on the anniversary date of the permit, an <br />opetntor shall submit the annual fee, a rcporl: and map showing the extent of current disnubanees to affected <br />Land, reclainatian accomplished to date and during the preee3ing year, new d%sturbances that aie anticipated to <br />occur during the upcoming year, reclamation that will be performed dttting the coming year, ehe dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Pieasc atWCh vour revised written annual report sod anneal rcnort map to this form. Please nose that are <br />adequately labeled map shat clearly delineates and induder the above elements may since for a written report. <br />Division recorda indicate the following pcmtittee contact information. Please verify and make any necessary <br />changes: <br />Pcrmittcc Contact; Eric Prieve <br />Permitter Name: Colorado Division of highways <br />Address: 4340 E. Louisiana Ave. <br />Denver, CO 80222 <br />Phone Number: <br />Pare Number: <br />(303)757-9249 <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 farm along with your written report and map. Annual, Report instructions are enclosed. <br />~~~~~ <br />Signature o. Corporate Officer ar Owner 1 r ,~,t,,~.{r,~ re,,,,, o v 2p~ <br />IV a <br />~~ Z9-~~/ <br />Date 1'^ Z OU`3 <br />