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ANNUAL FEE and REPORT REpUEST <br />PERMITTEE NAME: <br />PERMTT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Aggregate Industries -WCR, Inc. <br />M-1989-029 <br />Longmont Distel Operations <br />December 7, 2001 <br />RECElilE© <br />,~~~ ; 2 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. 34-32-11b,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 your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following pemuttee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Patrick Ward <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: - <br />Aggregate Industries -WCR, Inc. <br />3605 S. Teller St. <br />Lakewood, CO 80235 <br />(303) 985-1070 <br />If you have additional comments and/or information that should be <br />belo it to this form along with your written report and map. <br />V v~ <br />Signature of C rpora Officer or Owner <br />~~~~~~2 <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />M 1PERMIiV.1 ASTERDOCUMENTSN1-AF-01 <br />