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<br />/7f i~'PT <br /> A,/Nn"^NTTAi. FF.F. and RF,PiIRT RF.niTF,ST <br />PERMITTEE NAME: Lafarge West, Inc. ~/ <br />~ <br /> / <br />'J'! U ;' Z~~ <br />PERMIT NO.: ~.1GI-1991-035 <br />OPERATION NAME: Bluestone Pit / <br />ANNNERSARY DATE: November 5, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Jefferson <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`tr7-e 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 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~nrt and anm~al report man 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 fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Reckentine <br />Permittee Name: Lafarge West, Inc. <br />Address: 10170 Church Ranch Wy. Ste. 200 <br />Westminster, CO 80021 <br />Phone Number: <br />Fax Number: <br />(303) 657330 <br />(303)657-4339 <br />30~-105 - ~IUJ~ ~ <br />~~- c~s~ - ~to ~,-t <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 />Signature of Corporate Officer, Owner, or Designee <br />~~. 31, ~.cx~~ <br />Date <br />