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x <br /> <br />RECESVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Department of Transportation <br />M-1996-007 <br />Spring Creek Pass <br />May 2, 2004 <br />APR 1.9 2004 <br /> <br />$688.00 (Due on or before your anniversary date) <br />Hinsdale <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 />__.- operatorshalLsubmit_the_annual fee, wort 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 anmial re~yD~rt and anneal report man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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 />Pennittee Name: Colorado Department of Transportation <br />Address: 4340 E. Louisiana Ave. <br />Denver, CO 80222 <br />Phone Number: <br />Fax Number: <br />(303)757-9269 <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 />Signature of Corporate Officer, Owner, or Designee <br />~ ~ r~- ~ L~ <br />Date <br />a v o 3 ~y>u~~~ <br />,~~ ~ <br />M:~PERMI'nA1ASTEADOC;UMENTSVvf-AF-04 <br />