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<br />R~~E~~~® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-1996-082 <br />Blair Mesa Pit <br />November 15, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Rio Blanco <br />OCT 2 82003 <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-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 ymm revised written annual renurt and anmral r~urt m"1p to this fnrm_ 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: Julie M. Mikulas <br />Permittee Name: Lafarge West, [nc. <br />Address: C/o Lafarge Highway Div. <br />P. O. Box 2187 <br />Ft. Collins, CO 80522 <br />Phone Number: (970) 407-3669 /~.~, ~~~r~ <br />JFax-Number: - -- -- - -- -- ~%~/ % TD7`' .~ 9~-7 - - ---- -- - <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~~~ ~1~a~ti <br />Si ature of Corporate Officer, Owner, or Designee <br />l~(z7~o3 <br />Date <br />MiPERMITU-IASTER000UMEN75VN-AF-0I <br />