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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />a7- <br />ANNOKIFEE:ind REPORr REQUEST <br />gregate Industries - WCR, Inc. <br />?ZAJ <br />E 8th Street Operation <br />May 3, 2010 <br /> <br /> <br />I'M i 2010 <br />?;emRWWFWWM, <br />oK <br />?AY MiCgIVED <br />1 2010 <br />Division of P.TG uMMon. <br />Wining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Weld <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, 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 -d-at- e`s Tor 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. 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 Year's map are necessary, then no new may 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: Connie N. Davis <br />Permittee Name: Aggregate Industries - WCR, Inc. <br />Address: 1707 Cole Blvd., Ste. 100 <br />Golden, CO 80401 <br />Phone Number: -2005 7? - 33? - G S?d G <br />Fax Number: (970) 378-6856 <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 />Signature of Corporate Officer, Owner, or Designee <br />S= <br />Date