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<br />PERMTI'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />_ ~9_ a~ <br />Lafarge West, Inc. <br />M-1980-136 <br />Chambers Pit <br />November 15, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Eagle <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 far the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annual report and annnal rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Steven Wood <br />Permittee Name: Lafarge West, Inc. <br />Address: P.O. Box 368 <br />Glenwood Springs, CO 81602 <br />Phone Number: (970) 704-4804 <br />Fax Number: (970) 704-4818 <br />-l r.~'~n~c n ~ . <br />iDl7c~ Ch~xrh R~n~.h <br />cn ~ r i CO ~--~ <br />303- X57- ~33c7 <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 />/~ e~ 23 <br />Date <br />