Laserfiche WebLink
ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />According to-C.R,S..3A_32.5=116 or C.R.S_34-32_1.1.6„each_year,~the anniyeraary 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 during 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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maa. If no new disturbances or reclamation have occurred durine the previous vear and no new changes to <br />the previous year's moo are necessary, then no new moo is required, provided that the Ouerator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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 />Holcim (US) Inc. <br />M-1977-344 <br />Portland Limestone Quarry <br />October 10, 2007 <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <br />Permittee Contact: David A. King <br />Pennittee Name: <br />Address: <br />Holcim (US) Inc. <br />P.O. Box 350 <br />Phone Number: <br />Fax Number: <br />Ignacio, CO 81501 <br />(970)382-0609 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />