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0 diz <br />ok-, <br />ANNUAL FEE and REP RT RE 0 UEST <br />PERMITTEE NAME: A,enver Water Department RECMM <br />PERMIT NO.: / �/1GI- 1979 -195 !" DEC 3 0 2009 <br />OPERATION NAME: Road Runner Rest Division of Reclamation, <br />ANNIVERSARY DATE: January 28, 2010 <br />l Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />- - According to- C.R. -S -34= 32:5 -1 -16 or C.R:S: 34 32 1 -1 -6, -each year-,_on the anniversary date of_ the-perm it,-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 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: John H. Bambei Jr <br />Permittee Name: Denver Water Department <br />Address: 1600 W. 12th Ave. <br />Phone Number: <br />Fax Number: <br />Denver, CO 80204 <br />(303) 628 -6669 <br />(303) 628 -6851 <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 />S'gna ure of Corpor to fficer, Owner, or Designee <br />l Z - 29 -01 <br />Date <br />