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<br />RECEIVED <br />JUN 2 0 2005 <br />Oiuision of Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-2004-040 <br />Las Animas Pit <br />June 15, 2005 <br />$438.00 (Due on or before your anniversary date) <br />Bent <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 [he 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 far the year, if any. <br />Please attach ynnr revised written anmral re~nnrt and anmral re on rt man 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Julie Mikulas <br />Permittee Name: Lafarge West, Inc. <br />Address: , <br />Phone Number: (970) 407-3669 <br />Fax Number: (970) 407-3907 <br />P.U, ~x ~1~1 <br />r-F Cv U i vts~j kt~ZZ <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 />Si lure of Corporate Owner, or Designee <br />~/~s~~ <br />Date <br />