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<br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Oldcastle SW Group, Inc. dba Four Corners Mate ' <br />PERMIT NO.: M-1983-028 ~~~ ~'~~~' <br />OPERATION NAME: Wallace Pit MAR 0 ~ ?~~~ <br />ANNNERSARY DATE: February 24, 2004 <br />®iVision of Minera,y ,,,y ~ <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) n~ <br />COUNTY: Montezuma <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected _ . <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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. 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: Marcia Talvitie <br />Permittee Name: Oldcastle SW Group, Inc. dba Four Comers Materials <br />Address: P. O. Box 2707 <br />Phone Number: <br />Fax Number: <br />Durango, CO 81302 <br />(970) 247-2172 <br />(970)259-3631 <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 />of M4rci~ zoca5 <br />Date <br />