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ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: ?-Oldcastle SW Group, Inc dba Four Corners Materials <br />.,,AFEB 18 2010 <br />PERMIT NO.: / M-1983-028 <br />OPERATION NAME: Wallace Pit DiviWn of Reclamation, <br />Mining and Safety <br />1201, ANNIVERSARY DATE: February 24, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <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 />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 necessarv, 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mar-ei T°' y <br />Mme- Qe-nall n <br />Permittee Name: Oldcastle SW Group, Inc dba Four Corners Materials <br />Address: P.O. Box 1969 <br />Bayfield, CO 81122-1969 <br />Phone Number: (970) 247-2172 <br />Fax Number: (970) 259-3631 <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 />--;?','&CLI <br />Signature o Corporate Officer, Owner, or Designee <br />2115 ?2'01c) <br />Date