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.. ~~ <br />~ ~ ~~C 2 2 21,04 <br />O <br />PERMITTEE NAME: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />PERMIT NO.: M-1983-142 <br />OPERATION NAME: Hall Pit <br />ANNIVERSARY DATE: December 21, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 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 yonr revised written annnal report and annnal re o,~ rt mgn 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: Brent W. Ken <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) 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 />l~ ~~ i~ . ~1i ~) <br />Signature of Corporate Officer, Owner, or Designee <br />L~.z~e..wy ~ ~ U 4-- <br />Date J <br />