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?F -+- zirr <br />ANNUAL FEE and REPORT REOUEST <br /> <br />PERMITTEE NAME: 00- <br />Oldcastle SW Group, Inc dba Four Corners Materials <br />PERMIT NO.: /M-1987-038 <br /> <br />OPERATIO / j 2 6 ?Q09 <br />OC ` <br />N NAME: Bayfeld Pit No. 1 ? <br /> <br />_ <br />Dtvi"n of <br />- <br />ANNIVERSARY DATE: November 15, 2009 Minh+O 8 <br />ANNUAL FEE DUE: $791.00 (Due on or before our anniversary date <br />your ) <br />COUNTY: La Plata <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 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 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 />man. 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 may 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: Peter Kearl <br />Permittee Name: Oldcastle SW Group, Inc dba Four Corners Materials <br />Address: P.O. Box 1969 <br />Bayfield, CO 81122 <br />Phone Number: (970) 247-2172 <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 />/0-.20-0 <br />Date