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<br />~/ <br />~5 <br />ANNiIAI. FRF, and RF.PnRT RF,t7ifF.CT <br />-, ~^~'. <br />..... ~ ~~ .W J'. <br />PERMITTEE NAME: Lafarge West, Inc. <br />PERMIT NO.: M-1483-013 <br />OPERATION NAME: Latham -Burkett Pit <br />ANNIVERSARY DATE: November 15, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <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 />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 attachrnnr revised written anneal report and anm~al re ern t map to this form- Please note that an <br />adequately labeled reap that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following pennittee 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. ';GI -lG ~ l .1C h K t~C h <br />h 1Cls~ , Cx ~~~~i ~ ~C:~(;'~~ <br />Denver, CO 80221 ~ L~ {/.}}jy'~ ~ 11 ~~_~ ~ ~ ~'~, <br />Phone Number: (303) 657330 <br />Fax Number: ~L =~ - (G ~] - ~ L}?j-7 <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 ,Z i ~ ~ 1L_i't, ~~~>n 1 ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />