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JRN-12-2005 15:44 FRDM:CDDT MATERIALS LAB 303-757-9008 <br />70:9702487292 <br />P.007~015 ~~ <br />~ GV~/ - <br />. _., L., ...~~ <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARX DATE; <br />ANNUAL FEE DIIE: <br />COUNTX: <br />Colorado Division of Highways <br />M-1979-142 <br />West of Maybell Pit <br />February 1+ 2005 <br />$685.00 (Due on or before your annivcrsarydate) /+ pa <br />MoffatMoffat 1f <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 <br />opaator shall submit the annual fee, a report and map showing the extent of current dishrrbances to affected <br />- ' 1'arrd, zcsrlamation aocoti5plished n dais' and duringtht<}nece~itXgyeai; new'disturTian~cs t t~aFaic antioipated td ~' - <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates far the <br />I beginning of active operntions, and the date active operations ceased for. the year, if any. <br />I P1~aa~nHS-e n +r r yiR~d wri}~Pa a11.11118I T'P}Inrf Rnd annnal rp. np H map to thCa form. p(gaS2 nOIC that 4n <br />adequately labeled map that clearly delineates and includes the a5ove elements may suJ~ce jot a written <br />~ report. <br />Division records indicate the following permittce contact information. Please verify and make any necessary <br />changes: <br />~ Pennittee Contact: Eric Prieve <br />~ Permittee Name: Colorado Divisian of Highways <br />Address: 4340 E. Louisiana Avc. <br />Dcnvcr, CO 80222 <br />Phone Number: (303) 757-9269 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below ar attach it to this foray along with your written report and map. Annual Report instructions are <br />enclosed. ' Q / <br />/~ ~ ~.Qw ~ ~.~i /~2 w..-o v-2 d <br />~~~ ~ y <br />Signature of Corporate Officer, Owner, or Designee ~ r ~ O 0 <br />-Z-I °- vs <br />~ Date <br />M:~PCaM nVAASrERDOC[1MaM:4~M.AF-04 <br />