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L <br />Le: c <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 Division of Highways <br />M-1979-111 <br />Enderson Pit <br />December 31, 2009 <br />$$323.00 (Due on or before your anniversary date) <br />Lincoln <br />According-to°C:R:S-34--32 55=1-1Z 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 disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during 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 If 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 map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Brent R. Loomis <br />Permittee Name: Colorado Division of Highways <br />Address: 4670 N Holly St <br />Denver, CO 80216 <br />Phone Number: (303) 398-6804 <br />Fax Number: (303) 398-6810 <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 />No 64101,? -? hc,S C'Ccrue'? i';-? Z-0act, <br />The pteulo'-'). 5.)bmdjed S,fe vl"i> <br />n..?_ jr pujs +ije co-tre j+- 9?cJos o <br />Signature of Corporate Officer or Owner -I h c P i +, <br />V/ 7/7010 <br />Date