2005-09-02_REPORT - M1977036

• Permit No: M1977036
• IBM Index Class Name: Report
• Doc Date: 9/2/2005
• Doc Name: Annual Fee/Report/Map
• From: Lafarge West Inc
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Lafarge West, Inc.
M-1977-036
Greeley 35th Ave Pit
August IS, 2005
$688.00 (Due on or before your anniversary date)
Weld
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
-- shall-submit the-annual-fee; a--report and-map showing the-extent-of-eurrent-disturbances-to-affeeted-land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach Xpur revised written anm.al report and annual report mare to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written repor[.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Eric Reckentine
Permittee Name: Lafarge West, htc.
Address: 10170 Church Ranch Way, Suite 200
Westminster, CO 80021
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
(.~~fl` ~ ~Q~O VIAL( l'C.l' ~`1~~_
Signature of Corporate Officer, Owner, or Designee
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Date