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^ ~ ~^ <br />~z-~- os <br />PERi~tITTEE NAiV[E: <br />PER.b[IT NO.: <br />OPERATION NAb(E: <br />ANNCVERSARY DATE <br />A~ i tAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />rvi- IG~XO- 131 <br />tl~ ~Yl ~ Cx1111v~ Q t~C <br />~OV~M1y~,C 15 i ~.00~ <br />5688.00 (Due on or before your anniversary date) <br />m~~- <br />According to C.R.S. 34-325-1 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual tee, a ceport and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, ne~v 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 />Plen~att~ch ynnr revised written annual rennrt ~nd~~nnn`tl re, rt map to thic form Please note [hat an <br />adequately labeled map that clearly delineates and includes the above elements may steffice for a written report. <br />Division records indicate the following permittee 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. 10\TO Ct(1l~Yl'\(l QIitY~ll_ <br />~ ~~-~ . ~~ <br />Denver, CO 30221 (,~.~-~-n~v t~~-}-e C, ~ gl~ <br />Phone dumber: (303) 65 7-=[330 ~~,~-(o~j-I- t--EC~YJ <br />Fax Number. (303) 657-4339 ~~-(~~~ ^ y 03`7 <br />[f you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i[ to this form along with your written report and map. _ynnual Report instructions are enclosed. <br />c°~ .~.~ ~ ~e c,~.t l~-~..n <br />Signature of Corporate Ofticer, Owner, or Designee <br />~tl r i'P/yl 12P r ~C X y ~(~CJ~ <br />Date <br />