2005-10-31_REPORT - M2000113

• Permit No: M2000113
• IBM Index Class Name: Report
• Doc Date: 10/31/2005
• Doc Name: Annual Fee/Report/Map
• From: Lafarge West Inc
• To: DMG
• Media Type: D
• Archive: No

S
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~i 1 /
ANNilAi, FF.F. and REPORT RF.OiTFST
~afarge West, Inc.
~NI-2000-113
Mamm Creek Sand & Gravel
October 29, 2005
$688.00 (Due on or before your anniversary date)
Garfield
~rI'V~
RE~E~'+IE~
~CT 3 1 2005

According to C.R.S. 34-32.5-I 16 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 ynnr revised written annual rennrt and annual rennrt maP 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:
Phone Number:
Fax Number:
10170 Church Ranch Way, Suite 200
Westminster, CO 80021
[phone]
[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.
~~-c _~ ~r~~ t~~ v /--
Signature of Corporate Officer, Owner, or Designee
~~/~~ ~~
Date