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fIF~K~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AN~NiTAi. FTF. and RF.PnRT RF.QiIFST <br />L/,afarge West, Ina. <br />//M-1980-136 <br />Chambers Pit <br />November 15, 2005 <br />~a <br />~~R~~ECEtV'~p~ <br />"NQV 3 0 ~ <br />QIYIS10n of Minerals end Ueeisuv <br />$688.00 (Due on or before your anniversary date) <br />Eagle <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-te -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 your revised written annual retort and anmral re~. n~ rt mgp 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 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 Way, Suite 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4330 G~O?> - (p~J7-4000 <br />Fax Number: (303)657-4339 ~b?j-- ~OrJ7-- ~0~~ <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 esignee <br />~(Jvt?rvt_~~' fig, .2~~ <br />Date <br />