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LO:C-20-2007 03:10PM FEONNOIV RfCLA14ATI0N DINING ~ SAFETY 30383281 Q2 T-024 P.003lDQ~ F-486 <br />PIrRMI'1"T'lr& lrl'.AME; <br />P'ERMX 1' PTO.. <br />OPEXtATION NAME: <br />ANNIVIrRSARY DATE: <br />ANNUAL FEE Di.TE: <br />CO(JNTY; <br />ANN[JA><. FEE and REPfJRT REQUE~'x' <br />Colnrado;livisioa of l~hways <br />11+i.19y9-3,1i <br />Enderson Fit <br />~ecQmber 31, Zb07 <br />$~323,Qp one on or before your anniversary date) <br />Lincoln <br />Acc,orditsg to C.R.S. 332.5-t 16 or C.R.S. 3A--32-116, each y~r~ oa the ~niversary elate of the permit, an <br />operator shall submit d+e annual fee, a report and map thawing the extent of current distarb$rrces to affected <br />land, reclamation acco~ztplishcd W date and during the preceding year, new disturbances that are anticipated to <br />occur during zlze upcoming year, reclamation that will be performed during the coming year, the dares far the <br />bco?~niAg L7i'active operations, and the date aCti~G q~p~rativKea ce~sea fpr the yaai, i;Fany, <br />)Pies'~~ attach vour rnvise~,,,~,~,~itfie~na,.n~al reottrc anci ~rraupl report man to this form. Tice Anau~ <br />Report & Fns regpit*~etanent is not met until we brave received the foiiovriztg components: fee, repat't~ anti <br />associated man. If no new ~8 aneea Ot' reclatnsti4Mt hart occurred dnriaa the orevioBS vest aad_na <br />.. sr.. ..l.R.. +.. tAn rrnvinnc vtrnr~c ma71 ~YN IfeC~lf9fRtV. tb871 n0 nevv InAlf ~$ rl~Lilri'dw nravided t118t the <br />Ouerator shall state tHis in tLe Annual Report. Please note that an adequately labeled rasp that clearly <br />delf~tetrtes and includes the above elements »eay su,~3ca for a written report. <br />Division records indicate the fol2ovving ptritfstotc contact irffprtnatib3f. Please verify sad make any n~~c~sary <br />clyatt~es: <br />Fermittee Contact; C,~ill~rt Montoya <br />PCnnittee Natne: Colorado Division of Highways ,_„T,., <br />A,ddress: 46y~ N Molly St - _--- _ ---- <br /> Denver, CO X0216 -- --- -- - -- <br />)'hone Number: (30~) 35$-G8Q4 <br />tr'ax Number: (303) 39$-bS10 - <br />If you have #dditional comments and/or information that should be rnovisied to the l]ivisioz,, ples~ provi$C it <br />below ar attach it to this form slang 1~rith your written re~rt and map. Annual Raport instructions are <br />enclosed. ~~~ p~~~i°usR~ Su~MCtT~ MP+P Coi~R~C~1..4' yl. i,P4CTS-CH~ CuRw;l~~1-r S~iA'iuS <br />Signature o'f Corporate Officer, pwraer, or Designee <br />Date <br />RECEIVE® <br />DEC 2 7 20('_~t <br />Division of Rec~~. - - <br />Mining and ~~ '~ ~' <br />M;Wt~N~Y1hIASTBRUMT3NTS112,11F•U4 <br />