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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and m_ap 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, [he 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 report and annual report map 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: Julie M. Goettemoeller <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />ANNUAL FEE and REPORT REQUEST <br />Lafarge West, Inc. <br />M-1996-082 <br />Blair Mesa Pit <br />November 15, 2002 <br />RECEeVED <br />NOV 2 5 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Rio Blanco <br />Lafage West, Inc. <br />Ft. Collins, CO 80522 <br />P.O. Box 2187 <br />(970)407-3669 <br />Ju ~i>° tug ,~[t/as <br />G~D NI.GtI,t,Wfltn ~ 1 yl SL(TYI~ <br />R7o- ~to7- 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 />/.~ f~/.~u~e- <br />Si ture of Corporate Officer, Owner, or Designee <br />!/~ZZ/o2 <br />Date <br />M:~PERMITU1ASTERD000MFNTSN~I-AF-01 <br />