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A_ NN& I EfE nd PORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: ?afarge West, Inc. <br />PERMIT NO.: VI-1987-131 JUN 15 2009 <br />OPERATION NAME: Penrose Pit Division of Reclamation, <br />ANNIVERSARY DATE: June 15, 2009 M niRg and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 />Please attach your 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 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) 657-4000 <br />Fax Number: (303) 657-4037 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />- Z'7 <br />Signature of Corporat O cer, Owner, or Designee <br />(0/1 <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed.