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.. ~ ~~~G:~i `~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />PERMIT NO.: /ICI-1980-022 <br />OPERATION NAME: Preston Pit Extension rr~;~,, <br />ANNIVERSARY DATE: February 2, 2007 '~ , '~~~Q~~® <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) !~ FEe ~ S 2 p pl <br />'~~clo~ n£ aGCl3mation, <br />COUNTY: Mesa N''~~n9 and 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, reclamatiorrthatwill be performed during the coming year, the datesfar the-beginning- ---- <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 />maa. If no new disturbances or reclamation have occurred during the urevious vear and no new chances to <br />the previous year's man are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Reuort. 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 fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Brent W. Kerr <br />Permittee Name: 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) 243-5946 <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 />Signature of Corporate Officer, Owner, or Designee <br />:. 2a a ~ <br />Date <br />