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ANNUAL FEE and RE _ REQUEST <br />PERMITTEE NAME: �%ggregate Industries - WCR, Inc. <br />PERMIT NO.: .4d-1994-093 <br />OPERATION NAME: Dahlia North Resources Pit <br />ANNIVERSARY DATE: December 31, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />Y <br />'DEC 2 2 2009 <br />Di*ion of Reclamatio n <br />Mining and Safety ' <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 atta vour revised writte 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 during the previous year and no new cha nges to <br />the previous year's map are necessary, then no new map is required, provided that the Operator s h a ll 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: Connie N. Davis <br />Permittee Name: Aggregate Industries - WCR, Inc. <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: (303) 985 -1070 <br />Fax Number: (970) 378 -6856 <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 />& 4N� <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />