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//~ f/~J l <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: //Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />PERMIT NO.: .~-1986-104 <br />OPERATION NAME: Montgomery Pit <br />ANNIVERSARY DATE: May 24, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUN'PY: Eagle <br /> <br />R~f~FI~/~'~ <br />~q w inn-/ <br />/~~h.r /_. LUUI <br />Di s:oam~~:~.;-~~~=ion, <br />~Niinin~ anG Safety <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 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 />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map 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: Jason Burkey <br />Permittee Name: Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />Address: P.O. Box 1729 <br />Edwards, CO 81632 <br />Phone Number: (970) 926-3311 <br />Fax Number: <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 />~~ ~~~~ <br />Signature f Corporate Officer, Owner, or Designee <br />y~9/o~ <br />Date <br />