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1-1+n.N\q'e4 ?qnfk <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Colorado Division of Highways <br />PERMIT NO.: M-1979-142 <br />OPERATION NAME: West of Maybell Pit <br />ANNIVERSARY DATE: February 1, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />19 <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-ma-p- 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 map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's may are necessary, then no new map 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 since 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 ?-jo - (p g3 - (? a3 <br />Fax Number: (970) 248-7292-' 3 <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 />Signatur of Corporate Officer, Owner, or Designee 7?'D i?'?G??u %U <br />Date <br />M:\PERMITIvIASTERDOCUMENI'S\M-AF-04