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dbZ <br />fl? ? c?flr <br />ANNUAL FEE and REPORT REQUEST U Jf;;??? J <br />PERMITTEE NAME: Lafarge West, Inc. ? ?,?,? <br />PERMIT NO.: M-1991-035 tt ?O? ?I?O? p <br />?1V?WiL ri u..:CGIYIGt?Oi'1, <br />OPERATION NAME: Bluestone Pit v ?? , n? ?r =? ?G ?tY <br />ANNIVERSARY DATE: November 5, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Jefferson <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 xhe_beginning_ <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 year'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 necessary <br />changes: <br />Permittee Contact: Robert O. Ray <br />Permittee Name: <br />Address <br />Lafarge West, Inc. <br />10170 Church Ranch Way, Ste. 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4579 <br />Fax Number: (303) 657-4037 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />J2aLqw or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />V <br />Signature of Corporate Offs , Owner, or Designee <br />I It 2--? <br />Date .r