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<br /> <br />~ECEG~°E® <br />PERMTI'TEE NAME: <br />PERMIT NO.: <br />OPEKATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-1977-036 <br />Greeley 35th Ave Pit <br />August 15, 2004 <br />SEP 2 7 ?004 <br />Division ai Minerals & Geology <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />~~ <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'Co date-anti-daring-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 annnal rennrt and anm.al re~nrt main, fn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Perruittee Contact: Eric Reckentine <br />Permittee Name: Lafarge West, Inc. <br />Address: 1400 W. 64th Ave. <br />Denver, CO 80221 <br />Phone Number: (303) 657-4330 <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 />Signature of Corporate Officer, Owner, or Designee <br />_ 4-2y- <br />Date <br />