2004-09-10_REPORT - M1997026

• Permit No: M1997026
• IBM Index Class Name: Report
• Doc Date: 9/10/2004
• Doc Name: Annual Fee/Report/Map
• From: Greg Lewicki And Associates
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Oldcastle SW Group, Inc. d.b.a. B & B Excavating
M-1997-026
Carol Ann Pit
September 8, 2004
$688.00 (Due on or before your anniversary date)
Eagle
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
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 ycaz,-new disturbances-that are-anticipated-taoccur----
during the upcoming yeaz, 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 rennrt and annual repnrf 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: Jason Burkey
Permittee Name: Oldcastle SW Group, Inc. d.b.a. B & B Excavating
Address: P.O. Box 1729
~ Phone Number:
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
,~~~~~~~
Signature ofrporate Of er, Owner, or Designee
g~3~oy
Date

5EP 10 2004
[Iivlsiod if Minerals and Geologq
Edwards, CO 81632
[phone]
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