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4\1P *- R -r <br />ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Oldcastle SW Group, Inc dba Four Corners Materials <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />JM-1980-228 <br />Triangle One Pit <br />April 27, 2010 <br />CIva <br />? APR 21 2010 <br />$791.00 (Due on or before your anniversary date) „-?, Alvlslon of Reclamatl®n, <br />1 Mining & Safety <br />Archuleta <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--accompl ched-to--date=and-during-the-preceding -year; -new-d banes=that-are-anticipated-to - <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 man is reauired, 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: 4ta M Y a-' <br />Maa4 C?Iv-rlatnzki <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 />b!Z7 along with your written report and map. Annual Report instructions are enclosed. <br />Signatur of Corporate Officer, Owner, or Designee <br />4/1°J /to <br />Date