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PERMITTEE NAME: <br />PERMTT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Aggregate Industries -WCR, Inc. <br />M-1992-069 <br />83rd Joint Venture <br />January 26, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 ~+nnr revised written anm~al repnrf and anm~at 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 informafion. Please verify and make any necessary <br />changes: <br />Permittee Contact: Michael C. Refer <br />Permittee Name: Aggregate Industries -WCR, Inc. <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401-3220 <br />Phone Number: (303) 985-1070 <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. Annua] Report instructions are enclosed. <br />Signature of Corp to O icer, Owner, r Designee <br />1 !o ~ %~ S <br />Date <br />