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AL FEE and REPORT REOUEST <br />PERMITTEE NAME: VOldcastle SW Group, Inc. dba Four Corners Materials <br />PERMIT NO.: _,?M-2005-045 ftcy"D <br />OPERATION NAME: Rock Dog #1 MAR 72 2010 <br />ANNIVERSARY DATE: March 13, 2010 -0y DM* M n ?ci+abonSf* <br />, <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <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_y_ear, new:disturbanc_,es that a_re_anticzipated 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 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 suffice for a written report. <br />Division records indicate the following permittee contact information <br />changes: <br />Permittee Contact: Peterl??trl <br />tin 2±E Ca"-natla*, <br />Permittee Name: Oldcastle SW Group, Inc. dba <br />Please verify and make any necessary <br />Four Corners Materials <br />Address: 6699 CR 521 <br />P.O. Box 1969 <br />Bayfield, CO 81122 <br />Phone Number: (970) 247-2172 <br />Fax Number: 259 -3031 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature A Corporate Officer, Owner, or Designee <br />Date 3 /0') Zlo