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NNUAL FEE and 1ZE ORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/Aggregate Industries -WCR, Inc. <br />„M-2004-051 <br />Wattenberg Lakes <br />February 10,2007 <br /> <br />a.i~ec j .acJ uai~iy <br />$$688.00 (Due on or before your anniversary date) <br />Weld <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_cunent 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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred durine the previous year and no new chances to <br />the previous year's mau are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Connie N. Davis <br />Permittee Name: Aggregate Industries -WCR, Inc. <br />Address: 1707 Cole Blvd, Ste. 100 <br />Golden, CO 80401 <br />Phone Number: (970) 353-2005 <br />Fax Number: (970) 378-6856 <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 aze enclosed. <br />~°i~~ ~ ~~ <br />Signature of Corporate Officer, Owner, or Desi ee <br />..5' 'O~ <br />Date <br />