Laserfiche WebLink
<br />Cif <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />d~afarge West, Inc. <br />M-1986-079 <br />M&GPit <br />August 3, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Adams <br />RECEIVED <br />,/ AUG 112006 <br />~Dlvision of Redama0on, <br />Mining and Safety <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 s'abmif the -annual fee°a ieport`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 yeaz, 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 vour revised written annual reuort and annual report maa 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 (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: `I <br />Permittee Contact: Land Department CF.PR.contact last name ~W 1~ U 1 Q} ( "~ <br />Permittee Name: Lafarge West, Inc. <br />Address: 10170 Church Ranch Way, Ste. 200 <br />Westminster, CO 80021 <br />Phone Number: (303) 657-4123 ,~j- ~p~j1- ~}(~''~11 t~~~ ~ <br />Fax Number: ~,~ ~0~1"' `-tV~~ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~ z~i~c'~a~t ~~~-P~ <br />Signature of Corporate Officer, Owner, or Designee <br />~r Y~ • i b , ~,1~ <br />Date <br />