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. x <br />A I;r 4;?- Q ?T <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: V) Colorado Division of Highways <br />PERMIT NO.: ? M-1979-155 <br />OPERATION NAME: Dotsero Cinder Pit <br />ANNIVERSARY DATE: February 1, 2011 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Eagle <br />--According to C.R.S.34-32.5.1.1.6 or C.R.S. 34-32-116,_ each year,_on_the-anniversary date-of_the_pertnit, -an -- <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />operator <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 vour 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 may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessarv. 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: Jason Smith <br />Permittee Name: Colorado Division of Highways <br />?P rF 14 <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 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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />V0 -14 eY-;, I re o-ovc j <br /> <br />Date <br />2v/v <br />M: PERMIT1MASTERDOCUMENTS\M-AF-04