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PERMITTEE NAME: Jefferson County ~~~' i <br />PERMIT NO.: M-1977-245 <br />OPERATION NAME: Pine Junction Pit <br />ANNP/ERSARY DATE: January 31, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Jefferson <br />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 <br />_ operator shall submit the annual fee, a r~rt and map showing the extent of current disturbances 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, 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 />Please attach ynnr revised written annnal report and annnal rapnrt m n this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the Following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: Paul G. Rice <br />Permittee Name: Jefferson County <br />Address: 21401 Golden Gate Canyon Rd. <br />~ a~e_ ~ LJ r~:~2~ <br />Golden, CO 80403-8108 <br />Phone Number: (303) 271-5205 <br />Fax Number: (303) 271-5222 <br />~c~~- ~~ 1 -' S2o6 <br />If you have additional comments and/or information that should 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 instructions are <br />enclosed. <br />W 6-d.+. ~ ~r~ ~Gv~ <br />Signature of Corporate Officer, Owner, or Designee <br />l~-~~ oS <br />Date <br />M:IPERMIT~M1tASTERDOCUMENTSNd-AF-04 <br />