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b~ ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />;/ ANNUAL FEE and REPORT REQUEST <br />/ Aggregate Industries -WCR, Inc. <br />~M-2004031 <br />Hazeltine Mine <br />September 27, 2006 <br />RECEIVED <br />// ~ hl~,~<, o :~ inns <br />/Division of Reclamation, <br />Mining and Safety <br />$688.00 (Due on or before your anniversary date) <br />Adams <br />~~ <br />According to C.R.S. 34-32.5-I 16 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 vour 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, 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 />suffrce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Connie Davis <br />Permittee Name: Aggregate [ndustries -WCR, Inc. <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: <br />Fax Number: <br />(970)353-2005 <br />(970)378-6856 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />L ~Z Li~/Gb ~~ <br />Signature of Corporate Officer, Owner, or esi n <br />~~~~~~ <br />Date <br />