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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'kv -*- 9't r <br />ANNUAL FEE and REPORT REQUEST <br />Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />M-1977-023 ./ <br />Ready Mix Pit RECEIVED <br />January 23, 2010 ,IAN 2 12010 <br />$791.00 (Due on or before your anniversary date) ivicion ar rieciamation, <br />Mining and Safety <br />Gunnison <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 />- ,-duri-ng-the-upcoming-year,-reclamation-that-wrH-be-performed-duringthe coming-year,-t h"e,es4or-the+eonning-- <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 during the previous year and no new changes to <br />the previous vear'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: Pete Siezymai ue.a Y- l <br />Permittee Name: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />Address: 2273 River Road <br />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 />1 - f. - (C <br />Date