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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~~` ~ <br />ANNUAL FEE an REPORT REQUEST <br />~I~rge West, Inc. <br />t'M-1988-042 <br />Cottonwood Pit <br />February 1S, 2007 <br />taFf:FIVED <br />~fEB 1 52001 <br />u+v+s+o f Reclamation, <br />ning and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Weld <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 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, reuort, and associated <br />map. If no new disturbances or reclamation have occurred during the nrevious year and no new chances to <br />the nrevious year's man are necessary, then no new man is required, arovided that the Operator shall state <br />this in the Annual ReAOrt. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may 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. CO 80021 <br />Phone Number: (303) 657-4123 <br />Fax Number: (303) 657-4037 <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 fficer, Owner, or Designee <br />Date <br />