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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />l~ <br />ANNUAL FEE and REPORT REQUEST <br />Aggregate Industries -WCR, Inc. <br />M-1989-029 <br />RECEIVED <br />DEC 0 9 2002 <br />Longmont Distel Operations <br />December 7, 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Weld <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 [he preceding year, new disturbance"s That are anticipated Yo occur <br />during the upcoming year, reclamation [hat 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. Please pore char an <br />adequately Labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Patrick Ward <br />Permittee Name: Aggregate Industries -WCR, Inc. <br />Address; 3605 S. Teller St. <br />Lakewood, CO 80235 <br />Phone Number: (303) 985-1070 <br />Fax Number: <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 />~ao tvov o a, <br />Date <br />M iPERM171MA5TERD000MENTSVN-AF-01 <br />