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,P?' -j- RPS <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />tlovOldcastle SW Group, Inc. dba Telluride Gravel <br />M-1976-032 ---' RECEIVED <br />Alexander Pit / JUN 16 2009 <br />June 17, 2009 (Division of mecramation, <br />$791.00 (Due on or before your anniversary date) Mining and Safety <br />San Miguel <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 vour revised written annual report and annual_reyort mat) 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 during the previous year :and no new changes to <br />the previous vear'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 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: Greg Homan <br />Permittee Name: Oldcastle SW Group, <br />Address: Drawer U <br />Cortez, CO 81321 <br />Phone Number: (970) 728-3775 <br />Fax Number: (970) 728-3015 <br />Inc. dba Telluride Gravel <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 />En/• Gk. <br />Signature of orporate Officer, Owner, or Designee <br />Date