2007-12-19_REPORT - M2003091

• Permit No: M2003091
• IBM Index Class Name: REPORT
• Doc Date: 12/19/2007
• Doc Name: Annual Fee/Report/Map
• From: Lafarge West, Inc
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lafarge West, Inc.
M-2003-091
Duckworth Pit
November 8, 2007
$$791.00 (Due on or before your anniversary date)
Weld
RECEIVED
DEC 19 2001
Divis~o~~ v'and Safety n
Mining
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 your revised written annual report and annual report man to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
mau. If no new disturbances or reclamation have occurred durinE the previous year and no new changes to
the previous year's man are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. 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: Robert O. Ray
Permittee Name: Lafarge West, Inc.
Address: 10170 Church Ranch Way, Ste. 200
Westminster, CO 80021
Phone Number: [phone]
Fax Number: [phone]
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.
~O~r ><
Signature of Corporate fficer, Owner, or Designee
~~..~~ - o
Date