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' v!4- <br />L <br />i <br />A AL F and PORT REQUEST <br />PERMITTEE NAME: D ver Water Department F-CF-ME® <br />PERMIT NO.: -1977-153 FEB 0 5 2010 <br />OPERATION NAME: Reclamation Pit No I. Divieion of Reclamation, <br />Mining and Safety <br />ANNIVERSARY DATE: February 7, 2010 4? <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />According to C.R.S. 34-32.5-116 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 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 />Denver, CO 80204 <br />Phone Number: (303) 628-6669 <br />Fax Number: (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 />gn ure of Corpor e ficer, Owner, or Designee <br />k:JZ -`f -jo <br />Date