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ANNUAL FEE and IIIEPORT REQUEST <br />PERMITTEE NAME: / Oldcastle SW Group, Inc. dba Four Corners Materials <br />PERMIT NO.: // M-1980-228 ~~~~-p ~ ~~~ <br />OPERATION NAME: Triangle One Pit '/ APR 3 <br />ANNP/ERSARY DATE: April 27, 2007 ~Wsion of r ~ 2~0~ <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) MininBandga etybn, <br />COUNTY: Archuleta <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 />__ _reclamatiorLacSOmplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will bee performed 3u-nng 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 report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, renort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the urevious year and no new chances to <br />the previous year's man are necessary, then no new man is required, arovided 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 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: Mazcia L. Talvitie <br />Permittee Name: <br />Address: <br />Oldcastle <br />SW Group, Inc. dba Four Comers Materials <br />~P.D. Box I91n9 <br /> <br />Phone Number: (970) 247-2172 <br />Fax Number: (970) 259-3631 <br />3Ciy~i'el~ CD Bll ,Zti'- X4104 <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 orporate fficer, Owner, or Designee <br />~r29~~ <br />Date <br />