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ANNUAL FEE and REPOKT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />~ M-1990-021 RECEIVED <br />./Virginia Acres <br />January 24, 2007 <br />SAN 2 62007 <br />/bivision of Reclamation, <br />$$688.00 (Due on or before your anniversary date) Mining and Safety <br />Mesa <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 curzent 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 yeaz, 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 vour revised written annual report and annual resort maa 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 durinti the arevious veer and no new chanties to <br />the arevious year's map are necessary. then no new map is required. 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. Kerz <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 />~3 ~ . ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />a.~..~ ~ 4 BOO <br />D <br />