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.: <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, 2004 <br />I rJ <br />RECEIVED <br />ocr 2 ~ 1ooa <br />Division ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date} <br />Rio Blanco <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 thafwill 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 ~r revised written annnal re~nnrt and anm~al r~nrt mat to 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 pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Julie M. Mikulas <br />Permittee Name: Lafarge West, Inc. <br />Address: C/o Lafarge IIighway Div. <br />P.O. Box 2187 <br />Ft. Collins, CO 80522 <br />Phone Number: (970) 407-3669 <br />Fax Number: (970) 407-3907 <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 />~i,lcc~ YY1~,~r,~~' ~Ldu~ ~: <br />S afore of Corporate Officer, weer, or Designee <br />-lrT/off <br />Date <br />