REP42222

• Permit No: M2000016
• IBM Index Class Name: Report
• Doc Date: 4/16/2004
• Doc Name: 2004 Annual Report
• From: Lafarge West Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECE9V ~ .~~~
PERMITTEE NAME:
PERiVQT NO.:
OPERATION N.a~~tE:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lafarge West, [nc.
M-2000-016
Riverbend Operation
March 26, 2004
APR 1 6 2004
Division of Minerals & Geolapy
5688.00 (Due on or before your anniversary date)
Weld
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 l6, each year, on the anniversary date of the permit, an operator
shall submit the annual tee, 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.
PIr ce~~ttach ynnr revised written nnnn~l rennrt and annnsl rennrt min to this form. Please note that an
~rdequately labeled map that clearly delineates and includes the above elements may st ffice 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 30221
Phone Number: [phone]
Fax Number: [phone]
[t' 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.
C~R..~ l~.~z~ntt~n ( /~
Signature of Corporate Ofticer, Own~er,,~ar Designee RECEGVE®
-~ ~ ~ ~y ~~y APR 16 2004
Date
Division of Minerais & Gaolopy