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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-1978-052 <br />Howe Pit <br />February 15,2005 <br />$688.00 (Due on or before your anniversary date) <br />Adams <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 cun-ent disturbances to affected land, <br />rec"-[-amat~on a-' ccompIishe to ate and~uni3g the prece3mg year,-new distur--trances t1iaY are an ~cipaYed 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 Ynnr revised written anneal re~Qrt and anneal rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following pennittee 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. ~ O1-? O (~ kl ~ IfC 4'l ~'Q~ ~'1 ~ 1~~'1,1,.I <br />boo ~J <br />Denver, CO 80221 t 1 (~ ~ 1(-' _ ~~ ~~-` <br />Phone Number: (303) 657-4330 JJ '' <br />-Fax Number: ~~3~ k~~~ ^ `-C~~j~ <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 />~ '~~~ ~-~ <br />Siggnature of Corpo(r~ate Officenr~Ow,ner, or Designee <br />Date <br />