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~S <br />ANNiIAi, FF.F, and RF,Pt1RT RF.QTTF.ST <br />PERMITTEE NAME: Lafarge West, Inc. <br />PERMIT NO.: M-1980-131 <br />.,.. L ~. %w=~ <br />OPERATION NAME: Bunn Ranch Pit _ <br />ANNIVERSARY DATE: November 15, 2004 ~`^'` "'" '~"'""7 <br />ANNUAL FEE DUE: $688.00 (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 the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any, <br />PlPace attach j~nnr revised written annual report and anneal renrnrt man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Reckentine <br />Permittee Name: Lafarge West, Inc. <br />Address: 1400 W. 64th Ave. <br />Denver, CO 80221 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4339 <br />Sono rh~xc7l P~n~h <br />~1.~'lil, sl~~'I-e, ~C~ <br />l ~-!'ml v~,b-t411 , CEO ~~1~-1 <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 />t ~ OF 0 Pr-~-r 4 ~~{ <br />Signature of Corporate Officer, Owner, or Designee <br />tikl,~ern a3~ a-cx>-1 <br />Date <br />