2001-04-04_REPORT - M1979148

• Permit No: M1979148
• IBM Index Class Name: Report
• Doc Date: 4/4/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

AR-30-2001 09:20 FROM:CDOT MATERIALS LAB 3037579008 TO:9702487292 111 11111111�11Il Ill y
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ANNUAL.FEE and REPORT REQUEST RECEIVED
APR 0 4 2001
PERMITTEE NAME: Colorado Division of Highways Division of Minerals and Geology
PERMIT NO.: M-1979-148
OPERATION NAME: Mytin Pit
ANNIVERSARY DATE: February 1,2001
ANNUAL FEE DUE: $281.00(Due on or before your anniversary date)
COUNTY: Routt
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
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual reQort and annual report may to tbis form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ilyess Ksouri E i L {�f\�V+✓
Perm ittee Name: Colorado Division of Highways 41. be ��. o' Tf ar1S�.r}Ay t D!\
Address: 4340 E. Louisiana Ave.
Denver,CO 90222 q
Phone Number: [phone] -�S 7 — 1 Z q C I
Fax Number:
Tf you have additional comments end/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Ri 4L, QN-�-� �� t-A+a-d�
Signature of Corporate Officcr or Owner
L-fl d
Date
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