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<br />FT- <br />f,l;:, J-- e <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE UEST <br />Skanska USA Civil West Rocky Mountain District, Inc <br />9 <br />M-1976-059 <br />Cortez Pit <br />June 17, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Montezuma <br />? Ite fc- 7 NAY p , <br />n <br />;,'j8; 2009 <br />Mirgiy79 and S? QtiG. <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,, the-dates-for-the-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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessarv. then no new map 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: Craig Wickstrom <br />Permittee Name: 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: <br />Fax Number: <br />(970) 565-8000 <br />970?SGS? <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 />Signature of orporate Officer, Owner, or Designee <br />Date