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..-,. <br />REC'~dV~"~ <br />MAY 2 7 2004 <br />Division of Minerals & ....~ioBY <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />M-1986-104 <br />Montgomery Pit <br />May 24, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Eagle <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=aeeomplished-to date and-during-the-preceding-year,-nesv-disturbances-that-are-articipaicd-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 ymnr revised written annnal tenor[ and annnal report man 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 />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 [his form along with your written report and map. Annual Report instructions are enclosed. <br />0.^pTnBl!!1l/lIry//////i <br />~~ •`~~~ ~~99~~% <br />-r' °, ~% <br />Signature Corporate Icer, Owner, or Desi~ee • - `'~ •• •, .. <br />Date y/~/Oy =~' ~,. ~_~ } <br />