2003-09-04_REPORT - M1980228

• Permit No: M1980228
• IBM Index Class Name: Report
• Doc Date: 9/4/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
SEP 0 4 2003
Ilivision ~f Minerals and Geobgy
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Oldcastle SW Group, Inc. dba Four Corners Materials
M-1980-228
Triangle One Pit
Apri127, 2003
$688.00 (Due on or before your anniversary date)
Archuleta
Aerne_,_ rrling rn (' R C 34-32-5.1 1(, nr C,R-$ '34-'27.1 I FreaclLyear,_on.the.anniversacy~ate.o£the.pertnit,an,operato~ _ -_
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anneal report and anneal re~nrt main to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: -~
Permittee Contact: Ma11T8'Potter /SZQ/"G/Q ~u/y/ f/C
PermitteeName: Oldcastle SW Group, Inc. dba Four Comers Materials
Address: P.O. Box 2707
Durango, CO 5203 $/302 ' 2707
Phone Number: [phone]
Fax Number: (9?O ~ Z5~!' 3(c ~
If you have additional comments and/or information that should be provided to the Division, please provide it
below or at~h it to this form along with your written report and map. Annual Report instructions are enclosed.

Signature
Owner, or Designee
9-2-03
Date
M:~PERMIi1MASTERD000MENTSUI-A F-01