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(/~~~ <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'~ ANNUAL FEE and REPORT REQUEST <br />`~ Aggregate Industries - WCR, Inc. <br />/M-1997-014 <br />Deer Creek Quarry <br />September 12, 2006 <br />i•Ll ifS72 <br />d-/5 -~~ <br />,, .. <br />~~:rt~'~ ~~dH` ~ <br />~~Il ~ 1 ~ 2~~~ <br />vision of Reclamation, <br />Mining and Safety <br />$688.00 (Due on or before your anniversary date) <br />Jelferson <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 snap 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 yeaz, 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, apd associated <br />map (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />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: 114ike•Refer <br />Permittee Name: Aggregate Industries - WCR, Inc, <br />Address: 1707 Cole Blvd., Ste. 100 <br />LOd /1 r •E /Y (/ a-V/ J L <br />Golden, CO 80401 <br />Phone Number: (303r98~1670 C~l9o~ 3s3-aaor <br />Fax Number: [ Cj ~JOLb~`7~ -lo d'irto <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 />~ ~'I- ~l~u2( <br />Signature of Corporate Officer, Owner, or Designee <br />//- /3 - ~/ <br />Date <br />