REP15565

• Permit No: M1998014
• IBM Index Class Name: Report
• Doc Date: 1/6/2004
• Doc Name: Annual Fee/Report Notice
• From: Lafarge West Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
AivNUAi. rr:E DUE:
COUNTY:
Lafarge West, Inc.
M-1998-014
Gypsum Ranch Sand & Gravel Pit
November 3, 2003
RECEI~/E®
JAN 0 6 2004
Division of Minerals & Geology
$688.00 (Due on or before your anniversary date)
Eagle
According to C.R.S. 34-32.5-I l6 or C.R.S. 34-32-116, each year, on the anniversary date of the permit. an operator
shall submit [he annual fee, a report and map showing the extent of current disturbances to affected land.
reclamation accomplished to dace and during the preceding year, new disturbances [hat aze 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 vour revised written annual reoort and annual report map to this form. Please Wore that an
adequately labeled map that clearly delineates and includes the above elements may suff ce for a written report.
Division records indicate the following permittee contact information. Please verify and make ,any necessary
changes:
Permittee Contact: Gary I. Tuttle
Permittee Name: Western Mobile, Inc.
Address: 1590 W. 12th Ave.
Eric Reckentine
Lafarge West, Inc.
1400 West 64th Avenue
Denver, CO 80204 Denver, CO 80221
Phone Number: [phone] [phone]
Fax Number: (303)657339 [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.
Signature of Corporate Officer, Owner, or Designee
Dace
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