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.bt-Y-, l~ <br />(~ ANNTiAT, FF.F, and RF.Pt7RT RF.OTIF.ST <br />PERMITTEE NAME: '~/Aggregate Industries - WCR, Ine. ~ECEIi/ED <br />PERMff NO.: f/ M-2004-031 t~MgY tt 9 20Q6 <br />OPERATION NAME: Hazeltine Mine <br />DiWeiea of Minere(a oed Oeolegy <br />ANNIVERSARY DATE: ember 27, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />rv1~Z~- <br />according to C:R:S-3=3=32°5=17"6 or C:R:S-34=3Z=1'T~ach 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 year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal repprt and annnal renart main 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: 1~4ilfe-R <br />Permittee Name: Aggregate Industries -WCR, Inc. <br />/oIf ni~~ J/G{"Vi~S <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone 1Vumber:~T f309j~985=1096-- ~ 970 ~ 3.5-,3- GODS' <br />Fax Number: ~9~~ ~ 3'7~ ~ loBS'6 <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 />Date <br />