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ANNUAL FEE and REPORT REQUEST <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Aggregate Industries - WCR, Inc. <br />M-1999-034 <br />Cooley Reservoir & Fulton Wildlife Area <br />September 9, 2006 <br />$$688.00 (Due on or before your anniversary date) <br />Adams <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 current disturbances to affected <br />land, reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated to <br />occur during the upcoming year, reclamaton 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 duriue the previous year and no <br />new chanties 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 following pernuttee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Connie N. Davis <br />Permittee Name: Aggregate Industries - WCR, inc. <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: (970) 353-2005 <br />Fax Number: (970) 378-6856 <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 aze enclosed. <br />Signature of Corporate Officer or Owner <br />Date <br />