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<br /> {,1-\{1 UI 40 (t <br /> ANNUAL FEE and REPORT REOUEST <br />o <br />??? <br />PERMITTEE NAME: Colorado Division of Highways <br />PERMIT NO.: M-1981-043 c? <br />OPERATION NAME: N Of Douglas Pass <br />ANNIVERSARY DATE: February 1, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <br />III\U--cr-,../?. <br /> <br />Divisio: -11N _& <br />-jon, -4 <br />Mining a,-,c agRrr3y <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 maD 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 man are necessarv. then no new maD is reauired. Drovided 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 (o ' D, a3 <br />Fax Number: (970) 248-7292 & ?? - (p o202? <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 />7 <br />S <br />Signature Corporate Officer, Owner, or Designee /? ??? !c c -0 'j <br />-0,9 <br />Date i?lu <br />M:\PERMIT\MASTERDOCUMENTS\M-AF-04