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= Mf?f'rc 05-2004~1n3:~37 FROM:CDOT MRTERIRLS LRB 303-757-9008 70:9702487292 P.005~017 <br />VV~ <br />ANN[JAL FEE and REPORT REQUEST <br />PERMI'ITEE NAME; Colorado Ifivislou of AJgbways APR 01 2004 <br />PSRbIIT NO.: 1~ .1979.142 <br />Division of Minerals & GeoloBY <br />OPERATIONNAMIi: West ofMaybellPit <br />ANNIVERSARX HATE: February 1, 2004 <br />ANNUAL FEE DUE: $688.00 (Doe nn or before yoar anniversary date) <br />COUNTX: Moffat <br />According to C.R.S. 34-32,S-116 or C.R.3. 34-32-11 G, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />]and, reclamation accomp-Tisltcd io date and during tllc prcaeding 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 far the year, if any. <br />~,learce attach vour revised written_annual rennrt and annual;eaort mau to this form, Please note that an <br />adequareiy fabeted reap [Isar efearly delineates and includes the above elements may suJjice for a WTilten report. <br />Division records indicate the following perntittee contact infatxrlation. Please verify and make arty necessary <br />changes; <br />Permittee Contact: Eric Prieve <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 Nwnbcr: <br />if you have additional comments and/or information that should be provided to khc Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~-~~ ~ ~~~~N ~ <br />Signature of Corporate Officer or Owner <br />3 ~-3 0 --oy <br />Date <br />!V d '~~S Nll~lY <br />f~ Z~~~ <br />