2016-12-16_REPORT - M1974070

• Permit No: M1974070
• IBM Index Class Name: Report
• Doc Date: 12/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Lafarge West, Inc. c/o Lafarge North America Inc.
• Annual Report Year: 2017
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:

Permittee Contact:

Christine Felz
Permittee Company:

Lafarge West, Inc. c/o Lafarge
North America Inc.

Address:

1687 Cole Blvd.
Suite 300
Golden, CO 80401

Phone Number:

[phone]
Fax Number:
Email Address:
Permitting Contact:

Anthony “Marshal” Miller
Company:

Lafarge North America Inc.
Address:

8700 W. Bryn Mawr Ave., Ste.
300
Chicago, IL 60631

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Anthony “Marshal” Miller
Company:

Lafarge North America Inc.
Address:

8700 W. Bryn Mawr Ave., Ste.
300
Chicago, IL 60631

Phone Number:

[phone]
Fax Number:
Email Address:

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01