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<br />ss5 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~/ ANNTiAi, FF.F, and RF.PnRT RF.OTTFST <br />/ Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />M-1977-022 <br />Pit No 3 / ~~~'~,'+,~~~ <br />March 2s, 2006 MAR C ~' 2006 <br />$281.00 (Due on or before your anniversary date) <br />Delta Division of Minerals and G=ology <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 ynnr revised written annnal report and anm~al report main M this form- Please note that 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: Brent Kerr <br />Permittee Name: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />Address: P.O. Box 3609 <br />Grand Junction, CO 81502 <br />Phone Number: (970) 243900 <br />Fax Number: (970) 243-5945 <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 />Date <br />