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OCT-11-2007 02:37PM FROM-DIV RECLAMATION MINING & SAFETY 3038328102 T-629 P-002/002 F-721 <br />lAf 7 A rm ?Ua <br />ANNUAL FEE and ]<tEPORT REOTJEST <br />PERMITTEE NAME: 'Lafarge West, Inc. RECEIVED <br />PERMIT NO.: A/L/-2000-113 -DEC 0 5 2007 <br />OPERATION NAME: Mamm Creek Sand & Gravel Div inn of Keciematipn <br />Mining and Safety <br />ANNIVERSARY DATE: October 29, 2007 <br />ANNUAL FEE DUE- $$791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <br />According to C.R.S. 34-32.5-116 or C.R.S. 3432-116, 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 coning 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 may 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 rcclamation have occurred during the previous vear and no new changes to <br />the previous vear's map are necessary, 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 accessary <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: "^" 657-4579 <br />Fax Number: (303) 6574037 <br />30-3 - LPG,1- 4 cro <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 />-Pw?j- o - 1'?=' / 0 <br />Signature of Corporate O icer, Owner, or Designee <br />Dates