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D , r-.~-.. C+ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />M-1994-097 REC~/ <br />Spring Creek Pit S. fP Z ~® <br />September 12, 2004 r7 <br />$688.00 (Due on or before your anniversary date) DI v~sin° °t M'°erals °°d0e°I°gy <br />Montrose <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-durhrgthe-precedingyear,-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 ynnr revised written anneal report and anneal report ma,p to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes; <br />n__.~ w.r,.n _t..,. <br />Permittee Contact: ~ruvriiaocncc- ~ f e n -~- w , ~~e p r- <br />PermitteeName: 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 <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, o Designee <br />Date ~~ <br />