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RECEIVED <br />. , EP 17 2008 <br />Division of Keck <br />ANNUAL FEE an _REPOR REOUEST <br />PERMITTEE NAME: Colorado Division of Highways <br />PERMIT NO.: /M-1978-102 <br />OPERATION NAME: Shippes Pit <br />ANNIVERSARY DATE: June 29, 2008 <br />f4aleg pue BuiuiVj <br />'uoi}eweiaaH to uoisiniC] <br />90OZ L L d3S <br />a3A13D3H <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />o l<, <br />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 <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 vour 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 may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessarv, then no new map is reauired. 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: Gary DeWitt <br />Permittee Name: Colorado Division of Highways <br />Address: 3971 W Service Rd <br />Evans, CO 80620 <br />Phone Number: (970) 506-0359 <br />Fax Number: <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 enclosed. <br />RECEIVED <br />Signature Corporate Officer or Owner SEP % 2008 <br />s 6? -9 vo'5 OMSkm of Reclamation, <br />Date and