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PERMITTEE NAME: Lafarge West, Inc. <br />PERMIT NO.: M-1974-070 <br />r-- ^. <br />OPERATION NAME: Nelson Pit ~ ~J ~ ~ ~y„J <br />ANNIVERSARY DATE: February 15, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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 pertnit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation-accomplishert-to-date-and during-the precedmgyear,-new-disturbancesthat-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 attac(;vm~r revised written anneal regprt and anm~al retort 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: Eric Reekentine <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 />1O l70 Cs-rc~rc h .l~c~nr b (ti,rt~t~/ <br />.~U(~-11 ~C) <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 />t~ir t o J !L ~ ~ P ~~t_,~ I~ <br />Signature of Corporate Officer, Owner; or Designee <br />Date <br />