2001-05-21_REPORT - M1996007

• Permit No: M1996007
• IBM Index Class Name: Report
• Doc Date: 5/21/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT 12EQUEST
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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Colorado Department of Transportation
M-199trU0'7
Sprins CreekPasa
May 2, 2001
MAY 1 1 2001
Division of Minerals and Geology
5550.00 (Due on or before your anniversary date)
Hinsdale
According [o C.R.S_ 3432.5-116 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 extant of cwrent disturbances to affected
land, reelan[ation accomplished to date and during the preceding year; new disturbances #hat aro anticipated to
occur during the upcoming year, recLgmation that will be performed during the coming yeaz, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
labeled map that clearly
report.
includes the
form. Please note that m,
,nay su~ee for a written
Division records indicate the following perntittee contact information. Please verify and make any necessary
changes:
Permittee Contact: -Ilyesn-iFsoafr~ ~~~c ~~rorr
Pvrmittee Name: Colorado Department of Transportation
Address: 4340 E. Louisiana Ave.
Denver, CO 80222
PhoneNumbnr: ('~3}~5~9d~12-~- .~3'7S7~
Fax Number
If you Gave additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your writen report and map. Annual Report instntctions aze
enclosed.
~~~~
Signature of Corporate Officer or Owner
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Date
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