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~~~~P~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Aggregate Industries - W CR, Inc. <br />PERMIT NO.: ~M-1992-069 <br />OPERATION NAME: 83rd Joint Venture <br />ANNNERSARY DATE: January 26, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />SAN 3 120p~ <br />Vision o`Recta <br />Nininy and ~atioq, <br />Safe,y <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 disturfiances`fhat aze`anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, 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 resort 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 />maa. If no new disturbances or reclamation have occurred during the arevious vear and no new chances to <br />the previous year's map are necessary, then no new mac is required, urovided 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: Connie N. Davis <br />Permittee Name: Aggregate Industries - WCR, Inc <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: E393}9Y5-1-0ZQ, ~ rf ~fb ~ ~, $ ~ 3 - ,2dGZ ~ <br />Fax Number: (9~6~ 3?~' G8S(, <br />If you have additional comments and/or information that should be provided to the Division, please provide <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 />/~~ ~ 4 7 <br />Date <br />