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r 1 `~T_ <br />1 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Aggregate Industries -WCR, Inc. <br />M-1985-112 <br />Loloff Mine <br />February 4, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECEIVE® <br />FEB 13 2001 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-1 16 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 [o date and during the preceding year; new disturbances thataie anticipated`to`occur <br />during the upcoming year, reclamation [hat will be performed during [he coming year, [he dates for 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. 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: Patrick Ward <br />Permittee Name: Aggregate Industries -WCR, Inc. <br />Address: 3605 S. Teller St. <br /> Lakewood, CO 80235 <br />Phone Number: (303)985-]070 <br />--- --Fzx-Nambee. - - - -- ---- - -- <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 of Corporate Officer or Owner <br />2 ~ <<~,o Z <br />Date <br />M:NERM 171MASTERDOCUM ENTSVN.AF-01 <br />