2009-06-24_REPORT - M1981014

• Permit No: M1981014
• IBM Index Class Name: REPORT
• Doc Date: 6/24/2009
• Doc Name: Annual Fee/Report/Map
• From: Oldcastle SW Group, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
*- PvI
ANNUAL FEE and REPORT REOUEST
k/
Oldcastle SW Group, Inc. dba United Companies of Mesa County
M-1981-014 L/
Rozman Pit
June 29, 2009

`f JUN 2 4 2009
$791.00 (Due on or before your anniversary date DN*m of Reclan9ation,
Mipong and Safety
Gunnison
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the up gcomin -year reclamation thaC-will bep gerfornred?d ring ?themidfnYear,g tthe=dates forcthe-be inning?-- ? "
-
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report may to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's map are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Pete Siegmt[f?zh
?vST• ^ ? v?v?
Permittee Name: Oldcastle SW Group, Inc. dba United Companies of Mesa County
Address: 2273 River Road
P.O. Box 3609
Grand Junction, CO 81502 -?_ - - _ - ?,_ - - -- - - ---f --- _~
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
ignature of Corporate Officer, Owner, or Designee
?zlo S
Date