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d"01 <br />AA-FEE'arid REPORT REOUEST <br />PERMITTEE NAME: Lafarge West, Inc. <br />PERMIT NO.: P-IM- 4977-036 RECEIVED <br />/ <br />OPERATION NAME: Greeley 35th Ave Pit VA <br />UG, 2 0 2008 <br />ANNIVERSARY DATE: August 15, 2008 *Division of Redamation, <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) Mining and Safety <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 permit, an operator shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to-date and during the.-preceding-year,- new disturbances that are anticipated to-occur during. the upcoming <br />year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the <br />date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report man to this form. The Annual Report & Fee <br />requirement is not met until we have received the following components: fee, report, and associated map. If no <br />new disturbances or reclamation have occurred during the previous year and no new changes to the previous <br />year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: Robert Ray <br />Permittee Name <br />Address: <br />Lafarge West, Inc. <br />10170 Church Ranch Way, Ste. 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4579 <br />Fax Number: (303) 657-4037 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below or <br />attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate r, Owner, or Designee <br />Date