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:, <br />f <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~F ~Rr'~i <br />AN~NIlAi. FF,F. and RF,P(7RT RF.t7iiF.ST <br />Lafarge West, Inc. <br />~I-1996-082 <br />Blair Mesa Pit <br />November 15, 2005 <br />esc <br />RECEIVED <br />~NDV 3 0 2005 <br />Division of Minerals end Geology <br />$688.00 (Due on or before your anniversary date) <br />Rio Blanco <br />According t, o 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 y~rr revised written anneal re~nnrt and anneal re,Qnrt man M this form- Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Julie M. Mikulas <br />Permittee Name: Lafarge West, Inc. <br /> <br />Address: ,n <br />P.O. BoxJ?]x7~ 1$1 Y .U • goX ~I ~S~ <br /> Fort Collins, CO 80522 <br />Phone Number: (970) 407-3669 <br />Fax Number: (970) 407-3907 <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 />~uCc,c,~1 ?~/ucG~-- <br />S' ature of Corporate OfFicer, Owner, or Designee <br />d <br />I!~7~0.~ <br />Date <br />