2008-01-16_REPORT - M1979195

• Permit No: M1979195
• IBM Index Class Name: REPORT
• Doc Date: 1/16/2008
• Doc Name: Annual Fee/Report/Map
• From: Denver Water Department
• To: DRMS
• Media Type: D
• Archive: No

PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~~ ~ R~
ANNUAL FEE and REPORT RE~jQUEST
Denver Water Department /
M-1979-195 ,~
Road Runner Rest
January 28, 2008
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$$791.00 (Due on or before your anniversary date)
Adams
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-are -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 map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's map are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. 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: John H. Bambei Jr
Permittee Name: Denver Water Department
Address: 1600 W. 12th Ave.
Phone Number:
Fax Number:
Denver, CO 80204
[phone]
[phone]
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.
gn ture of Corporat O facer, Owner, or Designee
i - ~.~-off
Date