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COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT <br />WQCD 2000 700 COR040204 000025800 5/24/2004 700015098 ~C~ <br />COLORADO STORMWATER DISCHARGE PERMIT SYSTEM INVOICE: 700015098 <br />ATTN: David L. Bucknam PLEASE MAKE ANY ADDRESS <br />Colorado Div of Minerals & Geology CORRECTIONS ON REVERSE <br />1313 Sherman Street, Rm 215 <br />Denver CO 80203 AMOUNT DUE: $258.00 <br />DETACH AND RETURN TOP PORTION WITH PAYMENT <br />JUN P 8 20U4 <br />NOTE: FAII,URE TO RETURN TOP PORTION OF INVOICE WiTA EXACT PAYMENT MAY REn Of NLlnetals & Geology <br />IN A POSTINGDELAY ORIN TBE RHPROPERCRIDTTING OF YOUR ACCOUNT. IMP <br />STATEMENT OF ANNUAL FEES <br />COLORADO STORMWATER DISCHARGE PERMIT SYSTEM <br />BILLING DATE: 5/24/2004 INVOICE NUMBER: 700015098 <br />BII.LING PERIOD: July Ol, 2004 to June 30, 2005 DUE DATE: 07/31/2004 <br />FEES CHARGED <br />$258.00 <br />PERMIT # COR040204 <br />Type: Active mineral mines<10 acres - SW only /General Permits (07/12) <br />County: Pitkin <br />Name of Site: Coal Basin Reclaim Cons. Projects <br />David L. Buckram - <br />Colozado Div of Minerals & Geology <br />1313 Sherman Street, Rm 215 <br />Denver CO 80203 <br />TOTAL CURRENT CHARGES: <br />~~ g"~'y . <br />$258.00 <br />~, <br />COMMENTS: <br />-~ ~~~ <br />To assure proper credit, please include the permit numbs on your check and return the top portion of this invoice with <br />your check. <br />MAKE CHECK COLORADO DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT <br />PAYABLE and 4300 Cherry Creek Drive South <br />RETURN Mail Code ASD-AR-BI <br />PAYMENT TO > DENVER, CO 80246-1530 <br />INQUIRIES: (303) 692-3616 <br />