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<br />ANNIiAI. FF.F, and REPORT RF.ni1F,ST ~~~~e V ~~ <br />DEC 0 ~ 1003 <br />PERMITTEE NAME: Lafarge West, Inc. ~+ion of <br />PERMIT NO.: M-1980-131 hfnerals and 6eolop, <br />OPERATION NAME: Bunn Ranch Pit <br />ANNIVERSARY DATE: November 15, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <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 />shallsubmit_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 attachynur revised written annual rennrt and annual re nn rt man 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: 1400 W. 64th Ave. <br />Denver. CO 80221 <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 this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />,/o~ 2,,rea~ <br />Date <br />M iPERM ITVNASTERDOCUMENTSU-I-AF-01 <br />