2004-09-27_REPORT - M1977439

• Permit No: M1977439
• IBM Index Class Name: Report
• Doc Date: 9/27/2004
• 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:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lafarge West, Inc.
M-1977-439
Home Office Mine
August 15, 2004

SEP 2 I X004
Division of Minerals & Geology
$688.00 (Due on or before your anniversary date)
Lorimer
According to C.A.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,
cec amation accomph`shed~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.
Plea!re attach ymrr revised written anmial renrnrt and annnal repprt m n this form. 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.
Phone Number:
Fax-Number:
Denver, CO 80221
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to [his form along with your written report and map. Annual Report instructions are enclosed.
A~~ , ~ ,r sz
Signature of Corporate Officer, Owner, or Designee
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Date