REP23265

• Permit No: M1977098
• IBM Index Class Name: Report
• Doc Date: 12/3/2003
• Doc Name: Annual Fee/Report Notice
• From: Lafarge West Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lafarge West, Inc.
M-1977-098
Sievers Pit
November 15, 2003
$688.00 (Due on or before your anniversary date)
Garfield
RECEIa/ED
DEC 0 321103
Division of Minnrals and Geoloq~
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 current disturbances. to affected 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 ynnr revised written annnal rennrt and annnal rennrt m ~n to this fnrm_ Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Eric Reckentine
Permittee Name: Lafarge West, Inc.
Address: 1400 W. 64th Ave.
Denver, CO 80221
Phone Number: [phone]
Fax Number: - - ~ _ - ~ - -- - - - _ -
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.
Signa re of orporate Officer, Owner, or Designee
"~,~~ 2~ zdet~
Date

M:\PE RM ITMASTERDOCUM ENTSUI-AF-01