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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Camas Colorado, Inc. <br />M-1985-112 <br />Loloff Miue <br />February 4,2001 <br /> <br />AUa !...~ <br />Division o1 Mini, _.- ...~~ ,.ala4Y <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary dale of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances thpt are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming ye8r, the dates For the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual resort mao to this form. ,Please note [hat an <br />adequately labeled mnp that clearly delineates and includes the above elements Wray sirjfice jor a wruten <br />report. <br />Division records indicate the following permittee contact information. Please verify and rftake any necessary <br />changes: <br />Permittee Contact: Mike Refer <br />Permittee Name: Camas Colorado, Inc. <br />Address: 3605 S. Teller St. <br />Lakewood, CO 80235 <br />Phone Number: (303) 716-5312 <br />Fax Number: <br />If you have additional comments and/or information [hat should be provided to the Divisiop, please provide it <br />below or attach it to this form along with your written report and map. Annual Repdrt instructions are <br />enclosed. <br />i ~/~ <br />~ I L~ <br />Signature o Corpo ate Officer or Owner <br />~ 2 ~a ~ <br />Date <br />ANNUAL FEE and REPORT REQUEST <br />M:IPERM IT Vv1A5TERDOCUhff NT51A1-AF-01 <br />