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i <br />~-` ~ ~ ~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />PERMITNO.: / M-1977-020 REC'~IV~D <br />OPERATION NAME: Pit No 1 -MAR 2 7 2007 ~ ~` <br />ANNIVERSARY DATE: March 23, 2007 <br />~ivisien of Reclamation, r„ „, ~ t ~ <br />ANNUAL FEE DUE: $$688.00 (Due on or before yotli+m~9t4P@r~d~ydate) p;, <br />w~u ~~~ ~9 e~ io SatetyJ~~, <br />COUNTY: Delta <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, _ <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary, then no new man is reauired, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Brent W. Kerr <br />Permittee Name: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />Address: P.O. Box 3609 <br />Grand Junction, CO 81502 <br />Phone Number: (970) 243-4900 <br />Fax Number: (970) 243-5945 <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 />Signature of Corporate Officer, Owner, or Designee <br />~ ~-~ ~-3. 2.00 7 <br />Date <br /> <br />