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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-1974-004 <br />Specification Aggregates Quarry <br />February 15, 2004 <br />FEB 1 7 2004 <br />Division of Minerals & Geology <br />$688.00 (Due on or before your anniversary date) <br />Jefferson <br />_ _ According to_C.RS. 34-32.5-L16_or_C.R.S. 34,32-116,. each-year, on the anniversa_ry_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 operafions, and the date active operations ceased for the year, if any. <br />Please attach your revised written anm>lal retort and annnal re nn rt map 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 following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Reckentine <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Lafarge West, Inc. <br />1400 W. 64th Ave. <br />Denver, CO 80221 <br />(303) 657-4330 <br />(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 aze enclosed. <br />Signature of Corpora a er, Owner, or Designee <br />°` /~~1~ <br />Date <br />M:IPERMI71MAS7ERD000MENTSIM-AF-01 <br />