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~v 1 <br /> ~~~~ ~~~• <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Colorado Division o ighways V <br />PERMIT NO.: M-1985-170 <br />OPERATION NAME: BLM Burnt Shale Pit <br />ANNIVERSARY DATE: February 1, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <br />~IECEIVE® <br />MAR 2 ~ 2008 / <br />Division of Ra Safety n,~ <br />Mining a V <br />Accordi_n_g to C.R.S. 34-32.5-116 or C.R.S. 34-32-11E, each year, on the anniversary date 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 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 your revised written annual report and annual report map to this form The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred durin the previous year and no <br />new changes to the previous year's map are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jason Smith <br />Permittee Name: Colorado Division of Highways <br />Address: 222 S 6th St Rm 317 <br />Grand Junction, CO 81501 <br />Phone Number: (970) 248-7239 ~9T~) ~ 8 ,~ - X22 ~~ <br />Fax Number: (970) 248-7292 ~~~ 7n) ~~ ,~ - X22 ~ <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 />Signature of C orate Officer, Owner, or Designee ~ J` ~d ~.~11.5 GF ~i`lT~~Q//f L <br />Date <br />-iy- ae <br /> <br />~UO S/6.•t/ It/G~.~T Ch`.9..t~ ~ Tv /~Cr4P. <br />M:~PERMI7IMASTERDOCUM ENTSUvf-AF-04 <br />