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~-~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ Lafarge West, Inc. <br />PERMIT NO.: t/M-1981-088 <br />OPERATION NAME: McCoy Pit <br />ANNNERSARY DATE: November 15, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Routt <br />ti~~ <br />i~~a~~ <br />Oivisi ''7Qn6 <br />Mir°i~9 'and Sa e y an <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-duringthe preceding year,-riew 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 mau to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's moo are necessary, then no new moo is required, provided that the Operator shall state <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />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, 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 />~3-1~~7- ~oeo ~ <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 />~x it ~ ~c ~ ~~~~ ~-~ <br />Signature of Corporate Officer, Owner, or Designee <br />1~.Te ~~, ~i5 aoeco <br />Date <br />