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1 r <br />~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-2000-113 <br />Mamm Creek Sand & Gravet <br />October 29,2004 <br />$688.00 (Due on or before your anniversary date) <br />Garfield <br />.f,n <br />L(i! <br />f ~~f 2 ~~J' <br />i~isina cr'i .r .... <br />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 <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and daring the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal rennrt anri ann .a~e,~nrt m n this form- Please note tha[ an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John W. Rozelle <br />Permittee Name: Lafarge West, Inc. <br />Address: 1400 W. 64th Ave. <br />Denver, CO 80221 <br />Phone Number: (303) 657-4336 <br />Fax Number: <br />Nr <br />I i !C~ C.k PJ'7~1 /~ <br />/O/7D ~Ur'~ I, ilk nr~ <br />Wa_t.l Sc ~~fP BOO <br />c,~~ ~~sae~-~, co g~ai <br />303- (oS7- X000 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~r~c ~ ~C.12,!' ,~ n~i~ 0~ <br />Signature of Corporate Officer, Owner, or Designee <br />~v~n,ber ,~3, ~~ <br />Date <br />