2017-02-14_REPORT - M1974070

• Permit No: M1974070
• IBM Index Class Name: REPORT
• Doc Date: 2/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Lafargw West, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: PSH
• 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: n
Company: Lafffge N@AhOmeriett tffc—.
Address: 87QQ SAT ve.,7e.
C Ic I
Phone Number:
Fax Number:
Email Address: ('C T I'1 S I ae, 1-f_+ Z )r'tU
Inspection Contact: ">\!mRhat"NAM— ,.
Company:
Address: .,Ste.
3�W
Phone Number: ( -
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.
(",aw lu
Signature of Permittee,Coriporatibfficer,Owner,or Documented Designee Date
M-AF-01