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JIB <br />ANN&ALFEcE"' <br />and REPORT REQUEST <br />PERMITTEE NAME: Lafarge West, Inc. y 2 4" 2010 <br />PERMIT NO.: ?M-1977-036 I C?g?M__ r,,,a?a €on, <br />OPERATION NAME: Greeley 35th Ave Pit i Kcal r a! tj Safety <br />ANNIVERSARY DATE: August 15, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />o.-, <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 -distur-bances-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 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 changes to <br />the previous vear's map are necessarv, then no new map is required, 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: Todd Ohlheiser / <br />t' T r ?I <br />Permittee Name: Lafarge West, Inc. <br />Address: 10170 Church Ranch Way, Ste. 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4000 <br />Fax Number: (303) 657-4172 <br />If you have additional comments and/or information that should be <br />,--b or attach <br />it to this form along with your written report and map. <br />0i <br />Signature of Corporate O fice , Owner, or Designee <br />s <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed.