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~ECE[VEC <br />ANNUAi, FF.F, and RF.PnRT RF,t]iiF.ST JUN 0 ,1 ~04 <br />Div,s,eg07Mineralsand Geology <br />PERMITTEE NAME: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />PERMIT NO.: M-1979-075 <br />OPERATION NAME: Chambers Gravel Pit <br />ANNNERSARY DATE: May 29, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <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 year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach yQpr revised written anm~al re~nrt and anm~al re nrn t man to this form. Please note chat 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 />Perm~tteeContact: `n:_L.. ]T,.1.«.. .. <br />Permittee Name: Oldcastle SW <br />Group, Inc. dba United Companies of Mesa County <br />Address: P. 0.3609 <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 />~~.~~~ [,c ~ . `~-~.~,,~,J <br />Signature of Corporate Officer, Owner, or Desi ee <br />~~ a ~ a~c~ <br />Date <br />