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~ S C~ <br />,/ ANNUAL FEE and REPORT REQUEST <br />PERMITTEENAME: <br />PERMITNO.: '~/Lafarge West,Iuc. <br />/ M-1979-191 "ECE~VED <br />/A~G ~ ~ 206 <br />OPERATION NAME: <br /> <br />ANNNERSARY DATE: Three Bells Pit <br /> <br />August 15, 2006 t/biv)sion of Reclamation, <br />Mining and Safety <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-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />- -shall su-bmit the` a`nnual`fee, a report and'map showing the eztenY 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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />mep (All are required regardless of the level of disturbance or absence of disturbauce during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />since 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, Inc. <br />Address: 10170 Church Ranch Way, Suite 200 <br />Westminster,,C0 80021 <br />Phone Number: (303) 657-4123 <br />Fax Number: (303) 657-4037 <br />303- lr~~-~-1t~1 <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 />~~~ 1 ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~('l. I,~ , ~~D <br />Date <br />