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~~ /ANNUAL FEE and REPORT REQUEST f~ r ,/ 6~.~:- PERMITTEE NAME: Aggregate Industries -WCR, Inc. - - _~~ /,{ PERMIT NO.: ~M-1999-034 ~~- ~.U~ Q 2 Z00~ OPERATION NAME: Cooley Reservoir & Fulton Wildlife Area - "~v~sion of rteciamation, Mining and Safety ANNIVERSARY DATE: September 9, 2006 ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) COUNTY: Adams According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the pennit, an operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map (All are required regardless of the level of disturbance or absence of disturbance during the previous year). Please note that an adequately labeled map that clearly delineates and includes the above elements may since for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Mike e~ Permittee Name: Aggregate Industries -WCR, Inc. Address: 1707 Cole Blvd., Ste. 100 Golden, CO Q0401 Phone Number: (393-983~t090---- ~~/'7,~/ ~ ,3.x,3- ,~2 0,~, s'- Fax Number: _ ~ 9 76 ~ 3 ~~-' w ~.I-~ ~ If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. Signature of Corporate Officer, Owner, or Designee (~ Date