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~nj <br />~p~ <br />JAN 2 ~: <br />JAN ~: 2GC5 <br />Zi;~5 <br />G ANNiTAi, FF.F, and RF.P(iRT RF.niTFST .vr•'. '. <br />PERMTTTEE NAME: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />PERMIT NO.: M-1990-021 <br />OPERATION NAME: Virginia Acres <br />ANNIVERSARY DATE: January 24, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <br />!~ <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_annttaL_fee,_a=report- and_map_sho_wing_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 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 re~nrf and annual re,Pn m to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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, <br />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, o Designee <br />o aa. a~c~sJ <br />