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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Oldcastle SW Group, Inc. dba Four Corners Materials <br />PERMIT NO.: M-1986-061 <br />OPERATION NAME: Cugnini Gravel Pit <br />ANNIVERSARY DATE: July 21, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) ' <br />COUNTY: La Plata <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 cur.ent-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. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Marcia Talvitie <br />Permittee Name: Oldcastle SW Group, Inc. dba Four Corners Materials <br />Address: P.O. Box 2707 <br />~ - - Phone Number: <br />Fax Number: <br />Durango, CO 81302-2707 <br />(970)247-2172 <br />~9~0) z.s9-3~ 3 / <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 enclosed. <br />Sig afore of orplateldfficer o~r Owner <br />7 Z5 ~o~ <br />Date <br />