2009-03-09_REPORT - M1985170

• Permit No: M1985170
• IBM Index Class Name: REPORT
• Doc Date: 3/9/2009
• Doc Name: Annual report
• From: Colorado Department of Highways
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Colorado Division of Highways t
M-1985-170 -""
BLM Burnt Shale Pit
February 1, 2009
$323.00 (Due on or before your anniversary date)
Garfield
ti

Division VI of ,. ,j1TTation,
Mining any Safety
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 may. 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: Jason Smith
Permittee Name: Colorado Division of Highways
Address: 222 S 6th St Rm 317
Grand Junction, CO 81501
Phone Number: [phone] (q?O
Fax Number: [phone] (?? 613 ???
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it t his form along with your written report and map. Annual Report instructions are
enclosed.
Signatur Corporate Officer, Owner, or Designee 175 ja)" XF'"CLi F-6
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Date
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