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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPdERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Otdcastle <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1-16, 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 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 the year, if any. <br />Please attach ynnr revised written annnal re,pnrt and annual rennrt main to this form. The Annual Reportt <br />& Fee requirement is not met until we have received the following 3 components: ss,.trRuft,and accnciated <br />~R (A113 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />su~ee 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: <br />Address: <br />P.O. Box 2707 <br />ANNiiAT, FF.F, and RF.PnRT RF.QiTIi',ST <br />/Oldcastle SW Group, Inc. dba Four Corners Materials <br />/ M-1986-061 RECE9\!ED <br />Cugnini Gravel Pit <br />~JUL 10 2006 <br />only zl, zoo6 <br />'~ Division of Minerals end GeolaBY <br />$688.00 (Due on or before your anniversary date) <br />La Plata <br />.rQA/'G4 L • TQ/vjlei~ <br /> <br />SW Group, Inc. dba Four Corners Materials <br />Durango, CO 81302-2707 <br />Phone Number; (970) 247-2172 <br />Fax Number: (970).257 ".310 3/ <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'yr" ,DO ~ <br />Signature of Corporate Officer, Owner, r Designee <br />07 Ju~ 2oci? <br />Date <br />