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R~ ~- RPT <br />PERMITTEE NAME: <br />PERMIT NO.: <br />ANNUAL FEE and REPORT REQUEST <br />Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />M-1997-026 / <br />~tECEIVED <br />~~ <br />OPERATION NAME: Carol Ann Pit SEP 13 2001 ~C~' <br />ANNIVERSARY DATE: September 8, 2007 Division o~ nq`~am1t1011, <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) Mining and Safety <br />COUNTY: Eagle <br />According to C.R.S. 34-32.5-I 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 to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming yeaz, reclamation that will be performed during the coming year, the dafes 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. 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 previous vear and no new chanties to <br />the previous year's map are necessary, then no new maa 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 />f~,srJ G,~,2~~% <br />Signa •e of Corporate Officer, Owner, or Designee <br />~8~67 <br />Date <br />