2006-02-16_REPORT - M1974004

• Permit No: M1974004
• IBM Index Class Name: Report
• Doc Date: 2/16/2006
• 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:
1/ ANNiiAT, FFF and RF,PORT RF.QTTFfiT
~/ Lafarge West, Iuc.
j/ M-1974-004
SpeciTication Aggregates Quarry
February 15,2006

~`~ FEB 7 G 2006
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Jefferson
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator
shall submitthe annual-'fee-a report' and' map showing the extenf of currenf disturbances o affected-lance;
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 err revised written annual re~ nrt and anmral rennrt man to 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: 10170 Church Ranch Way, Suite 200
Westminster, CO 8002]
Phone Number: [phone] °..~"~J ^ lo~j7' L(~C~
Fax Number: [phone] ~- (9~T - L~C~3"7
If you have additional comments andfor 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.
~~ ~ 1C~(' .1~ P 1~1 ,( LUl I
Signature of Corporate Officer, Owner', or Designee
~ JI3l(~(n
Date