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rte' <br />r ~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: / Lafarge West, Inc. RECE~VE~ <br />PERMIT NO.: / M-1998-014 ~ NQV ~ ~ ?OA6 <br />Division of Reclamation, <br />OPERATION NAME: Gypsum Ranch Pit Mining and Safety <br />ANNIVERSARY DATE: November 3, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Eagle <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 perfonned 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 />man. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since far n 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) 657123 <br />Fax Number: (303) 657-4037 <br />:~~~-- (aS-7- ~-l.C~co <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 />~-c~ ~c ~~~at9 1~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~.1e~'~t,~ 15 <br />Date <br />