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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />M-1998-024 <br />Hidden Valley Gravel Pit <br />RECEIVED <br />auc o s zoos <br />August 3, 2003 Division •f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Eagle <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 showtng the extent of wnent dtsiur anceb-~f`ected-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 [he year, if any. <br />Please attach ynnr revised written anneal report and annual re~nrt m}yl to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may 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: Jason Burkey <br />Permittee Name: Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />Address: P.O. Box 1729 <br />Phone Number: <br />Fax Number: <br />Edwards, CO 81632 <br />(970)926-3311 <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 />~r~ <br />Signatur f Corporate Off er, Owner, or Designee <br />g/3/~ ~ <br />Date <br />M iPERMINNASTERDOCUMEMSNI-AF-01 <br />