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fr-~ <br />t% ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: /Aggregate Industries -WCR, Inc. <br />PERMTI' NO.: ~M-1999-034 <br />OPERATION NAME: Cooley Reservoir & Fulton Wildlife Area <br />ANNIVERSARY DATE: September 9, 2006 <br />R pc'~,I~~ <br />M;;,°9a aos myos <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date ofthe permit, an operator <br />shall submit the annual fee, areport-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 vour revised written annual report and annual report moo to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact informafion. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mikcl~ <br />Permittee Name: Aggregate Industries -WCR, Inc. <br /> <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: ~9,~~ ~ .3~3- 02 OO i-- <br />Fax Number: ~ 9 7J ~ 3 %~~ r/o d',1-~ <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 />~ - 3i-o/ <br />Date <br />