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<br />ANNUAL FEE and REPORT REQUEST <br />Nov 'z z zoo2 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-1977-098 <br />Sievers Pit <br />November 15, 2002 <br />RECE@VED <br /> <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Garfield <br />According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, 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 eccorrspfiiShed`fo date and~uiin`g t-I"ie piece`ding 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 />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Gary J. Tuttle <br />Permittee Name: Lafarge West, lnc. <br />Address: 1590 W. 12th Ave. <br />Denver, CO 80204 <br />Phone Number: (303) 657-4123 <br />Fax Number ~ ~ _~33 q <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it [o this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of r ors to Officer, Owt er, or Designee <br />Date <br />M:~PERM I'M1ASTERD000MENTS~h1-AE-01 <br />