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MRR-0S-2004 13:45 FROM:CDOT MRTERIRLS LRB 303-757-9008 <br />PER.MI'TTEE NAME: <br />PE1ZMPf NO,; <br />OPERt1.TlON NAME: <br />ANNIVERSA1tY DA73/: <br />ANNUAL FEE DiJE: <br />COUNTY: <br />70:9702487292 P.017~017 <br />NUAL FEC and R1g1POR'T REO_UEST ~~(:~~!/~® <br />Colorado Division of ~ighwaya MAR 3 T 2004 <br />N1-198(037 Division of Minerals & Geology <br />RLN[ Olathe Rit <br />P'ebruat'y 1, 2004 <br />$281.00 (Doe nn or before ynnr annlveraary date) <br />Montrose <br />Accvrdmg to C.RS. 3432.5-11G or C.R,S. 34-32-] 1G, each year, on the anniversary date of the permit, an <br />operator shall submit the annual. fee, a report and map showing the catent of cut7'citt distu;banecs 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, reclamatian that will be performed during the coming year, the dates for the <br />~ beginning of active operations, and tltc date active operations ceased. for the year, if any. <br />Please attach vvnr revised written annual reno[t_and annual ~coert man to this form. Please note prat arA <br />adequately laheled map that clearly delineates and includes the above elements may saffrcefar a written report. <br />Division. records indicate the Following pcrmittee contact information. Please verify and make any necessary <br />changes: <br />Pemuttee Contact: ,Eric Pticwe <br />Pefmittee Name: Colorado Division of Highways <br />Address; 4340 P.. Louisiana Avc. <br />Denver, CO 80222 <br />Phone Number: (303) 757-92G9 <br />Faxklumbtr: <br />ff you have additional comments and/or information. that should be provided to the Aivision, plcage provide it <br />below or attach it to this form along with your written report and map. Annual 12eport instructions arc enclosed. <br />Sigrtntttrc of Carporatc Ok~lcer or Owner / <br />1 b L~ ~an5 /`P,^^o <br />~-2q-ov <br />Date ~ r^ 2 6 fl 3 <br />