2006-04-27_REPORT - M1983067

• Permit No: M1983067
• IBM Index Class Name: Report
• Doc Date: 4/27/2006
• Doc Name: Annual Fee/Report/Map
• From: Lafarge West Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
// AIVNiiAi. FFF. and RF,PnRT RF.nfiF.ST
'~ Lafarge West, Inc.
l~ M-1983-067
Stagecoach Pit
Apri120, 2006
RECEI'~E'~
LAPR 27 2406
ivisioo of Minorols anu:,uolu, y
$688.00 (Due on or before your anniversary date)
Adams
/vt~
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator
_shall submit_the_annual_£ee,_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 re~nrt ma,T to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may sufftce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Pennittee Contact: Eric Reckentine
Pennittee Name: Lafarge West, Inc.
Address: 10170 Church Ranch Way, Suite 200
Westminster, CO 80021
Phone Number: [phone].
Fax Number:
C1'k~~~k~ UICPJ j
~3-- (057- t-1~7~0
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.
J~ /LL~P~HO n sr II
Signature of Corporate Officer, Owner, or Designee
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