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6 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Colorado Division of Highways <br />U "'-1984-103 <br />Independence Pass <br />February 1, 2007 <br />~N 3 0 2001 <br />Divlsln , ar a°ci~mation, <br />P`^'in~ and Safety <br />$$281.00 (Due on or before your anniversary date) <br />Pitkin <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 />operator-shall-submit-the annual=fee,,-a-report-and-map showing-the-extent-of cunent~disturbances-to-affected---- <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 map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary. 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 since for a written report. <br />Division records indicate the fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rex Goodrich y~jSo.U ~~.r„jH <br />Permittee Name: Colorado Division of Highways --- ~ Ct5 /OhG d ~ Deaar'~'IYIP_ N'~" O f , <br />Address: 222 S 6th St Rm 317 i-Q h 5 Porfiattpn <br />Grand Junction, CO 81501 <br />Phone Number: (970) 248-7228 /~p70 ~ ' - 2 <br />Fax Number: `7 ~ d~ ~ '~ ~ ~ - ~ 2 / 2- <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 />>.-~ l <br />Sign re of Corporate Officer, Owner, or Designee ,{ /o ~A~KiRL R¢;~~vEfl t,~ :2 D(~ <br />/-22 -Q 7 /" <br />Date <br />M:~PERMI7IMASTERDOCUMENTS~M-AF-09 <br />