2001-04-04_REPORT - M1985170

• Permit No: M1985170
• IBM Index Class Name: Report
• Doc Date: 4/4/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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999
ANNUAL FEE and REPORT REQUEST
RECEIVED
PERMITTEE NAME: Colorado Division of Highways APR 0 4 2001
PERMIT NO.: M-1995-170
OPERATION NAME: BLM Burnt Shale Pit Division at Minerals and Geology
ANNIVERSARY DATE: February 1,2001
ANNUAL FEE DUE: $281.00(Due on or before your anniversary date)
COUNTY: Garfield
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 arc 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 report and annual report may to this 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: Ilycss Ksouri t C �r r✓v
Permittee Name: Colorado Division of Highways
Address: 4340 F. Louisiana Ave.
Denver,CO 80222
Phone Number: [phone] -7 9-7— 72 C 9
Fax Number:
If you have additional comments and/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. �/O
N o th n bnq I t` 7 1— z O O Q .
Signature of Corporate Officer or Owner
41z �o /
Date
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