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.h19R-f~5-2004 13:43 FRDM:CDDT MRTERIRLS LRB 303-757-9008 TD:9702487292 P.015'017 <br /> ANNUAL FEE and REPORT REO [TEST <br /> REGEIi/ED <br />I PERMITTEE NAME: Colorado Aivlsinn of 1HiRhwsys MAR 31 2004 <br />~ PERMIT NO.: M-1985-170 <br />OPERATION NAME: ]i1.M IInrot Shale Plt Division of Nilntr ~ , Geolosv <br />ANNIVERSARY DATE: February 1, 2004 <br />ANNUAL .FEE DUE: $281.00 (Doe on or before yanr anniversary date) <br />COUNTY: C.artield <br />According to C.RS. 34-32.5-i1G or C.R.S. 34-32-I16, each year, on the anniversary date of the permit, an <br />operator shall submit the armual fee, a report and map showing the extent of current disturbances to afFceted <br />I "' land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur dttting the upcoming year, reclamstion that will be performed during the coming year, the dates for the <br />beginnittg of active operations, attd the date active operations ceased far the year, ifany. <br />Please attach vonr revised written annual report and annual report man to this form. Please note that au <br />adequately lalieled map that cleariy dedineater and inchedes the above elements may since for a written report. <br />j Division records indicate the following permitter contact information. Please verify and mate any nccassary <br />changes: <br />Permi,ttee Contact: Eric Pnieve <br />Permittee Name: Colorado Division of Highways <br />Address: 4340 E. Louisiana Ave. <br />Denver, CO 80222 <br />Phone Number: (303) 757-9269 <br />Pax Number: <br />If you have additional comments and/or information that shou]d 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 insmrctions arc enclosed. <br />Signahtre of Corporate Officcx or Owner ~ o ~'^ f (`Q wr o,reo~ <br />3-z 9-~y <br />Date 11` 2 UO 3 <br />