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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Lafarge West, Inc. <br />M-1977-439 <br />Home Office Mine <br />August 15, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Larimer <br />RECEIVED <br />SEP 0 4 2002 <br />Division of Minerals and Geology <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 ma-p showing Y ie extent of'cu~rent~ist~ urbances-to affected land; - '~ ' - <br />reclamation accomplished to date and during the preceding year, new disturbances [hat 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 vour revised written annual report and annual report maa to this form. Please note that an <br />adega~ately labeled map that clearly delineates and includes the above elements may suffice for a writte~a 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: Lafage West, Inc. <br />Address: 1590 W. 12th Ave. <br /> Denver, CO 80204 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4339 <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 [his form along with your written report and map. Annual Report instmctions are enclosed. <br />~~ i~a~t.~..- <br />Signature of Corporate Officer or Owner <br />~~~02 <br />Dat~ <br />M:V'ERMI'nMASTERDOCUMENTSUf-AF-01 <br />