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. 1# <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNIIAL F EE a d REPORT REOUEST <br />A ect Materials <br />Select Materials <br />October 2, 2008 <br />$791.00 (Due on or before your anniversary date) <br />Weld <br />0lL <br />RECMVE C <br />CEP 2 9 2666 <br />Division of i-:cciamation, <br />46 Mining and Safety <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 Your revised written annual report and annual report man to this form The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durin the previous year and no new changes to <br />the previous year's map are necessary then no new map is required provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: - <br />Permittee Contact: Robert D. Oman <br />Permittee Name: <br />Address <br />Select Materials <br />P.O. Box 280 <br />Fort Lupton, CO 80621 <br />Phone Number: (303) 857-4688 <br />Fax Number: (303) 857-4638 <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 with your written report and map. Annual Report instructions are enclosed. <br />gnature f Corp ate Officer, Owner, or Designee OTC r°C7?/0, `?,'. Jlas <br />Date