2012-02-15_REPORT - M1979142

• Permit No: M1979142
• IBM Index Class Name: REPORT
• Doc Date: 2/15/2012
• Doc Name: ANNUAL FEE/REPORT
• From: COLO. DIVISION OF HIGHWAYS
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: DMC
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
or that the - were sans ory ex
Date
M XPERM IT MA STERDOCUM ENTS\M -AF -04
Jeremy Lucero
Colorado Division of Highways
222 S 6th St Rm 317
Grand Junction, CO 81501
(970) 683 -6223
(970) 683 -6227
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tal sndi
i pAeandillIon and complying with the specifications Oven
or f tft Oode and services are in contact compliance,
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Signature o Corporate Officer, Owner, or Designee
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ANNUAL FEE and REPORT REQUEST
Colorado Division of Highways
M- 1979 -142
West of Maybell Pit
February 1, 2012
$791.00 (Due on or before your anniversary date)
Moffat
RECEIVED
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-ra Division of Reclamation,
Mining & Safety
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred during the previous year and no
new changes to the previous year's map are necessary, then no new map is required, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly
delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
or information that should be provided to the Division, please provide it
g with your written report and map. Annual Report instructions are
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