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~ ~ '~~~ <br />u-~ <br />/ ANNUAL FEE and REPORT REQUEST <br /> '~ <br />PERMITTEENAME: /Lafarge West, Inc. REC~'~.,`~~ <br />/ <br />PERMIT NO.: / M-1980-136 ~~,t ., ry .,~ <br />~ i,~~ <br />OPERATION NAME: Chambers Pit ~ DlvlSlon r " ~ • '3rri~tion <br /> , <br />Mininp ana Safe <br /> <br />ANNPJERSARY DATE: <br />November 15, 2006 ty <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 acc2mplished to_date_and_during_the_preceding year, new dis[urbances.that aze 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 vour 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 />map. If no new disturbances or reclamation have occurred during the previous vear and no new chanties to <br />the arevious year's map are necessary, then no new maa 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />RECEIVED <br />Permittee Contact: Mark A. Vigil Nnv ~ ~ ~n~s <br />Division of Reclamation, <br />Pennittee Name: Lafarge West, Inc. Mining and Safety <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 />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 />~~ 1 ~ ~ ~Q ~ ~4 ~-~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~Tes~l~~~~ 1~ 2~ <br />Date <br />