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Pl? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />#?- 11 r <br />ANN AL FEE and REP RT REQUEST <br />Q-A gregate Industries - WCR, Inc. <br />/SEP 15 Zi-10 <br />AM-1997-014 Ujttislon of h'gedPi< a41on, <br />Deer Creek Quarry <br />September 12, 2010 <br />?? ?j <br />$$791.00 (Due on or before your anniversary date) <br />COUNTY: Jefferson Q <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 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: Connie N. Davis <br />Permittee Name: Aggregate Industries - WCR, Inc. <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: -E9?9}333 66? ??1? - & `l" 6 - o?r? <br />Fax Number: ( - -542- "716 <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 /> <br />Date