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~~ <br />1/AN1Vt1AT, FF.F and RF.P(1RT RF.[7TiFST <br />PERMITTEE NAME: !/ L~afarge West, Inc. RECEIVED <br />PERMIT NO.: t/M-1987-131 SUN 3 0 ?006 <br />OAPNNIVERSAR DATE: June 15, 2006 ~ivis'un ~f Minarals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 thafare 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 yn ~r revised written anneal report and anm~al report map to this form- Please 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: Mark A. Vigil <br />Permittee Name: Lafarge West,lnc. <br />Address: 10170 Church Ranch Way, Suite 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4123 ~~~ ~5~_ ~~ v/ <br />Fax Number: (303) 657-4339 3p3- (~5-f - t-1.b`~I <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 />~I~~ <br />Date <br />