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,w-o ~~ <br />V <br />PERMITTEE NAME: Oldcastle SW Group, Inc. dba United Companies osa County <br />PERMIT NO.: M-2002-110 ~°~f ~~~ <br />OPERATION NAME: 19 Road Pit FFB ? ~ 20~ <br />ANNIVERSARY DATE: February 25, 2004 ~~"`d9~otpn~nef~tS yn~C~oto <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) gy <br />COUNTY: Mesa <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 <br />operator shall submit the annual_fee,_a_reporLand_map_showirg-the-extent-of-current-disturbances-to affected- -- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal reFnrt and anneal rennrt map to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: /~ <br />Permittee Contact: -Fete~iegmcmd- /, ) r~ ri-{- ~ J~~ r ~- <br />Permittee Name: Oldcastle SW Group, Inc. dba United Companies of Mesa County <br />Address: 2273 River Rd. <br />P.O. Box 3609 <br />Grand Junction, CO 81502 <br />Phone Number: (970) 243-4900 <br />Fax Number: (970) 243-5945 <br />If you have additional comments and/or infonnation 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 <br />enclosed. <br />Sig`n~atur(e~of Corporate Officer, Owner, or Designee <br />'Y"e 15 Ju~.a` oZ 4'. .`~ ~~ <br />Date l <br />M:~PERMITIMASTERDOCUMEMSVA-AF-04 <br />