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/v <br />ANNIJAi, FF.F, and RF.PnRT RF.niJF,ST ~~~ <br />PERMITTEE NAME: Lafarge West, Inc. SEP ~ ~ 7~G4 <br />PERMIT NO.: M-1977-081 Ufvision of r,,,,, _ <br />OPERATION NAME: Greeley West Pit <br />ANNNERSARY DATE: August I5, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 />reelamafion-accomplishzd-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 ymir revised written annual report and annual re or,,~ t man to Chic form- Please note that an <br />adequately Zabeled 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: Eric Reckentine <br />Permittee Name: Lafarge West, Inc. <br />Address: 1400 W. 64th Ave. <br />Phone Number: <br />Fax Number: <br />Denver, CO 80221 <br />(303)657-4330 <br />(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 />Signature of Corporate Officer, Owner, or Designee <br />q-~y_c~ <br />Date <br />