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~~~~ ~~ ~ <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 Hi hwa s <br />/ g Y <br />M-1979-148 <br />Myrin Pit <br />February 1, 2008 <br /> <br />MAR 2 4 2008 ~ <br />Division ofi Reclamation, <br />Mining and Safety !/ <br />$$323.00 (Due on or before your anniversary date) <br />Routt <br />According to C.R.S. 34-32.5-1.16 or C.R.S. 34-32-1.16, 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 current 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 your revised written annual report and annual report map to this form The Annual <br />Report & Fee requirement is not met until vve have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinE 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jason Smith <br />Permittee Name: Colorado Division of Highways <br />Address: 222 S 6th St Rm 317 <br />Grand Junction, CO 81501 <br />Phone Number: (970) 248-7239 ~ ~~b) l'~', -3 -- ~~;Z~ <br />Fax Number: (970) 248-7292 ~~71j) ~,~ ~~ - X2,2 y <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 />Signatur of Corporate Officer, Owner, or Designee <br />~- iy -oP <br />Date <br />2~ ~~~ ~ ptiJ Or /~'!'1,~9TFiZ Irk L <br />~?~MOV~o ~w' =ZC~7 <br />/V~ ,S'~6N/f~~,~J l erlq~v~ € ro Nl~i'' <br />M: ~PERMIT~MASTERDOCUMENTS~Iv1-AF-04 <br />