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~l'7~ l~ l <br />PERMITTEE NAME: rge West, Inc. <br />PERMIT NO.: 77-098 <br />OPERATION NAME: Sievers Pit <br />ANNNERSARY DATE: November 15, 2005 <br />~ NOV 3 02005 <br />Division of Minerals and GooloBV <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <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 pern~it, 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 for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annual reDert and anneal report map to this form. Plea:~e 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: 10170 Church Ranch Way, Suite 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4330 <br />Fax Number: <br />~rr~ <br />RECEI'VE® <br />~~- ~ncJ7- ~~~ <br />3c~3- ~S7- ~D3 r <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 />l Jla-C ~ Kli-C~2n-(_i_~ 1, <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />ANNii <br />~9 <br />