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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Colorado Department of Transportation <br />M-1996-007 <br />Spring Creek Pass <br />May 2, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Hinsdale <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 dist<rrbances to affected <br />land, reclamation accomplished to date and during the preceding year, new dist3~rbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed duriaag 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 your 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: tf no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new xriap rs.regurred~_provided that .the <br />Oa~erator shall state this in the Annual Report. Please note that an adequately labeled neap that, clearly <br />delineates and includes the above elements may since for a written r•4PQrt. <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 Department of Transportation <br />Address: 222 S 6th St Rm 317 <br />Grand Junction, CO 81501 <br />Phone Number: (970) 683-6223 <br />Fax Number: (970) 683-6227 <br />If you have additional comments and/or information that should be p vided to the Division, please provide it <br />below or attach it to this form along with your written report nd map. Annual Report instructions are <br />enclosed. <br />:25G~ ra=ys k~ CIJC% <br /><...~,,~w~~`' J~-~~ roN s ~oR ~ Igo ~~ <br />39 <br />Signa of Corporate Officer, Owner, or Designee •~ <br />y, 2~'~ ro~uS TCT~ L <br />~~ ~~ ' ~ ~' 20~~ <br />Date ~`~~`~~~ 7~ <br />M:PERMIT'~MASTERDOCUMENI'S~Ivi-AF-04 <br />