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~~ <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. ~^ <br />~/M-1990-144 <br />Boone-Fillmore Pit <br />June 15, 2005 <br />-~ s_~:is,~~ 9 ~_ , <br />'~,~UG 3 i ~CC5 <br />. ~. 2xolcCtl <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, 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 ynnr revised written annnal re~nort and annnal r~nrt man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suf}'ice for a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Reckentine <br />Permittee Name: Lafarge West, Inc. <br />Address: 10170 Church Ranch Way, Suite 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4339 <br />~O3-~12~7 <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 />l /t /A' ~.,~®,/7~,t f'7l~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~(l~os <br />Date <br />