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K""" <br />PERMITTEE NAME <br />PERMIT NO.: % Z?r = J?qf r <br />ANNUAL FEE and REPORT REQUEST <br />gregate Industries - WCR, Inc. <br />4-Z-2004-031 <br />a)b Z <br />E EIV,ED <br />//OCT 0 7 2010 <br />OPERATION NAME: Hazeltine Mine <br />J?[:ivifii:ncy i?0c1ariation, <br />ANNIVERSARY DATE: September 27, 2010 & na ov <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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 vour 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 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. Please verify and make any necessary <br />changes: <br />Permittee Contact: Connie Davis <br />Permittee Name: Aggregate Industries - WCR, Inc. <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: (g7e ?- <br />Fax Number: 4?°7?'T ??4 ti4« <br />C 970) 35? -s-?-s-? <br />(3103) 714 S-3 %d <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 />eq - 6 `/eq <br />Date <br />