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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE and REPORT REQUEST <br />1!"17- <br />? Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />? M-1986-104 <br />Montgomery Pit <br />May 24, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Eagle <br />CXIV0 <br />l' MAY 2 5 201ia <br />Diviaprn Gi r cl2rralion, <br />UP Lfting 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 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 />Ma g. 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 sr f ce for a )vritten report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Jason Burkey <br />Permittee Name: Oldcastle SW Group, Inc. d.b.a. B & B Excavating <br />Address: P.O. Box 4870 <br />Eagle, CO 81631 <br />Phone Number: (970)926-3544, 9 70 32? / 73 y ZkT Z 2 9 <br />Fax Number: 9 70 328 1735' <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 />.114 ??'? /?o,Q ? l,G S '?d dpi Gba ?*Q EXCAdRti? d <br />Si ature of Corporate Officer, Owner, or Designee <br />Date