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)-e <br />ANNUAL FEE an REPORT E QUEST <br />PERMITTEE NAME: 6--470 Public Highway Authority <br />PERMIT NO.: VM-1980-1 l0 <br />OPERATION NAME,: Henderson Development <br />ANNIVERSARY DATE: September 9, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />ItECED <br />?Ep 0'L 2009 <br />Division of Reclamsfion, <br />Mining 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, 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 year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled niap that clearly delineates and includes the <br />alcove 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: Matt Alexander <br />Permittee Name: E-470 Public Highway Authority <br />Address: 22470 E. 6th Parkway <br />Aurora, CO 80018 <br />Phone Number: (303) 537-3470 <br />Fax Number: (303) 537-3472 <br />if you have additional comments and/or information that should be provided to the Division, please provide it <br />below or aWch it to this form along with your written report and map. Annual Report instructions are enclosed. <br />of Corporate Officer, Owner, or Designee <br />$f i)(b