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O'k <br />rs h <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE Q VE <br />� afarge West, Inc. <br />M- 1981 -088 <br />McCoy Pit <br />November 15, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Routt <br />NOV 2 3 2009 <br />ivi"a of Reolarna8 <br />Mining and Safety <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 anticipated to <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 a ttach Your revised written annual report and ann re port may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following compon fee, report, and associated <br />ma _ If no new distur bances or reclamation have occurred during the previous ye ar and no new changes to <br />the previous y ear's map are necessary, then no new map is requir pro vided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly d elineates 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: (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 <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />:� <br />Signature of Corporate Offs er, wner, or Designee <br />Date <br />