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~ V <br />ANNUAL FEE and REPORT REQUEST <br />PERMITI'EE NAME: Lafarge West, Ine. RECEIVED <br />PERMIT NO.: M-1979-191 <br /> SEP 0 6 2001 <br />OPERATION NAME: Three Bells Pit <br />ANNPJERSARY DATE: August 15, 2002 Division of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach your revised written annual resort and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and rncludes 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: ~;rie-Reele- <br />Permittee Name: Lafarge West, Inc. <br />Address: }-~!~9.a3C-].2tli.eue. <br />/Ylf}~ct l-{-A-Q~t/trr <br />~ ~0 U Al - 7~FFT H~I Li. /c p <br />Denier, ~26-862E)4 <br />Phone Number: (363}H"~,-4?t~_ <br />Fax Number: (3D3}65~339- <br />~7 . LoLL,i .y S F ~-U J~D S 3 j <br />q~(?- `~~7-3 cv0 v <br />-3~1UU <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 />_ , <br />Signature of Corporate Office or Owner <br />~?~S~Oz <br />Date <br />M NERM17U1ASTERD000MENTSVN,AF-Ol <br />