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REC~~`~ED <br />AUG 1 5 2003 <br />Oiuision ~tMinerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-1979-191 <br />Three Bells Pit <br />August 15, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Larimer <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 ext8nt of currenf 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 your revised written annnal rennrt and annual rennrt m ~n to this form. Please note that an <br />adequately labeled map that clear/y 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: VB1~flf~fl1 <br />Permittee Name: Lafarge West, Inc. <br />Address: <br />P_hone_Number:_ <br />Fax Number: <br />~96V1W.'~'! t~'BIt`~'~ <br /> <br />~Y) t, ~k~Vlf-i Y}~ <br />l ~ ~ ~Y'~ L-l~- <br /> <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 />U <br />Date <br />Officer, Owner, or Designee <br />M:~PERMI"f~MASTERD000M ENTSU4-AF-01 <br />