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l -• <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />QP , J, - 2e "-) <br />ANNUAL FEE and REPORT RE UEST <br />fSkanska USA Civil West Rocky Mountain District, Inc <br />M-1976-027 ? <br />Craig Pit <br />June 17, 2009 <br />$791.00 (Due on or before your anniversary date) <br />La Plata <br />C?? <br />--"' MAY 26 ZOOy <br />Division of Rec:?mztion, <br />Mid and Safety <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />- --during-the-upcoming-year,-reclamation-that-will-be performed-during-the-coming year; tlie=dates-for-th-e-beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's man are necessarv. then no new man is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: <br />Permittee Name: <br />Craig Wickstrom <br />Skanska USA Civil West Rocky Mountain District, Inc <br />Address: 22419 CR G <br />P. O. Box 1660 <br />Cortez, CO 81321 <br />Phone Number: (970) 565-8000 <br />Fax Number: <br />?045-4 -5-- O / 8-'y <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 />'r'4r?? - <br />Signatur of Corporate Officer, Owner, or Designee <br />Date