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t"V 4W C'? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE UEST <br />? Oldcastle SW Group, Inc. dba Telluride Gravel <br />M-1976-032 <br />Alexander Pit <br />June 17, 2011 <br />$791.00 (Due on or before your anniversary date) <br />San Miguel <br />RECEN <br />,?-/ JUN 177011 <br />®ivLa n ofa d Safety n, <br />fining <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: Greg Homan <br />Permittee Name: <br />Address: <br />Oldcastle SW Group, Inc. dba <br />270 HWY 625 <br />Telluride, CO 81435 <br />Phone Number: (970) 728-3775 <br />Fax Number: (970) 728-3015 <br />Telluride Gravel <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 />6466OMAAI <br />, C? 44== Signature o Corporate Officer, Owner, or Designee <br />- /? - Zo// <br />Date