REP48227

• Permit No: M1980136
• IBM Index Class Name: Report
• Doc Date: 12/22/2003
• Doc Name: Annual Fee/Report Notice
• From: Lafarge West Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Lafarge West, [nc.
M-1980-136
Chambers Pit
November 15, 2002
$688.00 (Due on or before your anniversary date)
Eagle
~iECE~VED
SEC 22 200
Oivisionof Mineta~ls&Ge0to9y
According to C.R.S. 34-32.5-1 i6 or C.R.S. 34-32-I 16, 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 vour revised written annual report and annual reuort mau to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice far a written report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Gary J. Tuttle
Permittee Name: Lafarge West, Inc.
Address: 1590 W. I2th St.
Eric Reckentine
1400 West 64th Avenue
Denver,CO 80204 Denver, CO 80221
Phone Number: [phone] [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide i[
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature~tif~Corporate caner, or Designee
Date
M:~PERM IT\h1ASTERD000MEM'SU1-AF-o I