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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Lafarge West, Inc. ~~~• ~ 9 ?Q07 <br />PERMIT NO.: M-1980-131 division al ~ec~am <br />9 and at-on <br />OPERATION NAME: Bunn Ranch Pit M~nm Safety <br />ANNIVERSARY DATE: November 15, 2007 <br />ANN[JAL FEE DUE: $$791.00 (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 />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"that will-be""performed during~tlie 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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's map are necessary, then no new map is reauired. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Robert O. Ray <br />Permittee Name: Lafarge West, Inc. <br />Address: 10170 Church Ranch Way, Ste. 200 <br />Westminster, CO 80021 <br />Phone Number: <br />Fax Number: <br />(303) 657-4579 <br />(303) 657-4037 <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, caner, or Designee <br />~~~ ~ - o ~ <br />Date <br />