2005-10-13_REPORT - M2000002

• Permit No: M2000002
• IBM Index Class Name: Report
• Doc Date: 10/13/2005
• Doc Name: Annual Fee/Report/Map
• From: Lafarge North America
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Lafarge West, Inc.
M-2000-002
Tanabe Pit
September 22, 2005
$688.00 (Due on or before your anniversary date)
Adams
- - Accordingto E:R:S-3432:5=1-lfi orC-.R:S-34=32-116,-each-ycar,-on-the-anmversary-datcofthe 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 your revised written annnal report and annnal rennrt maT to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since 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: 10170 Church Ranch Way, Suite 200
Westminster. CO 80021
- ~Pfione Number: - (303) 657=4330
Fax Number:
~3- ins7-037
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.
tC_2c~le_¢,n~,t_11 /~_
Signature of Corporate Officer, Owner, or Designee
Date