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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-1980-022 <br />Preston Pit Extension <br />February 2,2004 <br />$688.00 (Due on or before your anniversary date) <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-tl-.e extent'of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding yeaz, 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 yeaz, if any. <br />Please attach ~._r revised written ann ral report and annual re n, rf map 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: -Rie}mxd3elwsen- ~~ r~+~ "f l~ • '~e r a" <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) 2431!900 <br />Fax Number: (970) 243-5946 <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 />~~,,,,~- w . /~ <br />Signature of Corporate Officer, Owner, ortDesignee <br />Date <br />RECEIVED <br />FEB 0 5 2004 <br />-lvlalvn vt Minerals & Gea1o4'1 <br />M:~PERMITMASTERDOCUMEN'I'S~M-AFLI <br />