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F 4r- Re-1 <br />AL FEE and REPORT REOUEST <br />PERMITTEE NAME: V Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />PERMIT NO.: //M-1979-205 <br />R <br />OPERATION NAME: Chambers Pit © <br />ANNIVERSARY DATE: August 15, 2009 '-- p6G 0 6 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) ., Divisien of RedamatiOR, <br />// Mihing end Safety <br />COUNTY: Garfield <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 />_ .. . , ., • _ _.__ _ _ _ ____ ?•_?__L _?__.. ?L ,.a ....... ,.«ti:,.«..10.7-?..?.....,.,« <br />during the'upeoming 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 your revised written annual report and annual report may 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 during the previous year and no new changes 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 suff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rye;# rr°"" <br />-us J,^ Auier? <br />Permittee Name: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />Address: P.O. Box 3609 <br />Grand Junction, CO 81502 <br />Phone Number: (970) 243-4900 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date