2009-03-10_REPORT - M2000016

• Permit No: M2000016
• IBM Index Class Name: REPORT
• Doc Date: 3/10/2009
• Doc Name: Annual Fee/Report/Map
• From: Lafarge West, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: JLE
• Media Type: D
• Archive: No

PERMITTEE NAME
PERMIT NO.:
ANNUAL FEE and 1REPORT REQUEST
// le
rge West, Inc.
Z2-1000-016

-CSVED
4AR 10 2009
OPERATION NAME: Riverbend Operation MUM of Rea&nation,
ANNIVERSARY DATE: March 26, 2009 -7? Mbft MW Safety
ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date)
COUNTY: Weld
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 map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's map 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.
Signature of Corporate Off DgZr, or Designee
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Date