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e � 1 <br />LF1 E an REPORT REQUEST <br />PERMITTEE NAME: ��afarge West, Inc. <br />PERMIT NO.: �M- 1980 -136 <br />OPERATION NAME: Chambers Pit <br />ANNIVERSARY DATE: November 15, 2009 � <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Eagle <br />o� <br />FA <br />I�ECBlVfrD <br />NOV 2 3 2009 <br />Divisiew of Reclamafim, <br />Mining and Sqf* <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 — <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 att vour revised writt 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 changes to <br />the previous year's may are necessary, then no new may is required, provided that the Operator shal 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: (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 />Signature of Co orate Offi er, wrier, or Designee <br />Date <br />