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rco <br />~: '~P~°~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~Oldcastle SW Group, Inc dba Four Corners Materials <br />PERMIT NO.: i/IVI-1980-228 <br />-r- <br />OPERATION NAME: Triangle One Pit `'~' a,1~t`~~ <br />ANNIVERSARY DATE: Apri127, 2008 ~~~(( MAR 2 ~ 200$ <br />ANN[JAL FEE DUE: $$791.00 (Due on or before your anniversary date) v"'~1S10F' °i a~;~cFw.~ec~tion, <br />Mining and Sgfety <br />COUNTY: Archuleta <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, reclamation that will-be performed duririg the coming year, tfie dates- for the beginning- <br />ofactive operations, and the date active operations ceased for the year, if any. <br />Please attach your 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 />map. If no new disturbances or reclamation have occurred durinS the previous year and no new chanSes to <br />the previous year's map are necessary, then no new map 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 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: ~~~°°~° T Tom`'*~ ~~-f'ev- l~ , ~~~~"/ <br />Permittee Name: Oldcastle SW Group, Inc dba Four Corners Materials <br />Address: P.O. Box 1969 <br />Bayfield, CO 81122-1969 <br />Phone Number: (970) 247-2172 <br />Fax Number: (970) 259-3631 <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 fficer, Owner, or Designee <br />~/zs/2op~ <br />Date <br />