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<br />PERMITTEE NAME: Lafarge West, Inc. <br />PERMIT NO.: M-1974-004 <br />OPERATION NAME: Specification Aggregates Quarry <br />ANNIVERSARY DATE: February 15, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Jefferson <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 />'rectam~icS~acoomplished-to-datcand-during-the-preceding-yearnew-disturbanres ttiat arP ~nticipated.to occui___~ <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 cruised written anm~al rannrt and annual rep nn rt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Eric Reckentine <br />Permittee Name: Lafarge West, Inc. <br />Address: 1400 W. 64th Ave. <br />Denver, CO 80221 <br />OI70 ChU rnt `~~~ n <br />c_ I ~ oCt..tJ <br />~1.. ~ ~C ~ ~0~-7 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4037 <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 />Cx~.c~ K.~e .~ tZ~~ p /~ <br />Signature of Corporate Officer, Owner, or Designee <br />~.__ i~, a~os <br />Date <br />