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ANWAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Oldcastle SW Group, Inc dba Four Corners Materials <br />PERMIT NO.: /M-1980-228 <br />OPERATION NAME: Triangle One Pit 'WED <br />ANNIVERSARY DATE: April 27, 2011 /A? , Z011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date)/ ,?L'WAoy'. <br />Division o' and Sow <br />COUNTY: Archuleta Mining <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 />ec1 aarr tion-accQnplshed to _date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed durm" g tFcoming year; the3-atesTor 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 man 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: deter- l t'i-' l A ?4 P- , Ca? h 71)ae) <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 />below or att ch it to th' form along with your written report and map. Annual Report instructions are enclosed. <br />Signaturqdf Corporate Officer, Owner, or Designee <br />All ?Zoi <br />Date