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JRN-12-2005 15:50 FROM:CDOT MRTERIRLS LAB 303-757-9008 T0:97024B7292 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Alvision of Highways <br />M-1.979-148 <br />Myrin Pit <br />February 1, 2005 <br />$281.00 (Doe on or before your anniversary date) <br />Rontt <br />P.015~015 <br />!, <br />-~~ <br />~,.; „ <br />`~~~J <br />~r;~~u ..t -. <br />.,47rxts u A„ ~ <br />I <br /> <br />According to C.R.S. 34-32.5-I1G or C.R.S. 34-32-116, each year, on the anniversary date of dte permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances hr affected <br />lands revl¢matirnraccomplished trrdatc atxl-during-the~preoeding-year~ewdien~rlrwces that are anticipated to _.. <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Plraa~ ntfarfi yno~rgyLed wriffen nnnnal rnnnrt and anneal re~nnrt ma~tn„~hia form please note fhaf an <br />adequately labeled map that clearly delineates and includes thg above elements may ste~ce for a written <br />report. <br />Division records indicate the following permittee contact information, Please verify and make any necessary <br />changes; <br />Pernvittee Contact: Eric Prieve <br />Peratittee Name: Colorado Division of highways <br />Address: 4340 E. Louisiana Ave. <br />Denver, CO 80222 <br />Phone Number: <br />Fax Number: <br />(303)757-92G9 <br />If you have additional comments and/or inforntation that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report anal map. Annual Report instructions are <br />enclosed. <br />Sig afore of Corporate Officer, Owner, or Designee <br />Z /- o .S- <br />Dam <br />~i`Z 3 ~ ~~s r~~ev-ed <br />to 200 <br />M~IPEAMnMA$YaR9000M&NTSM-AF-09 <br />