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1 <br />w <br />RECEIVED <br />ANNUAL FEE and REPORT REQUEST <br />OCT 1 2 2001 <br />Division of Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Holnam, [nc. C/O Dundee Cement <br />M-1977-344 <br />Portland Limestone <br />October 10, 2001 <br />$688.00 (Due on or before your anniversary date) <br />Fremont <br />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 <br />shall submit the annual fee, a report and map showing the extent of curcent 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 reuort and annual reuort map to this form. Please more that an <br />ndequately labeled mnp that clearly delineates and includes the above elements pray since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: ~~~ / <br />PermitteeContact: Tracey Gunn ~t 'P / ~~,. \,y/1,/~ <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Holnam, Inc. C/O Dundee Cement <br />3500 St. Hwy. 120 <br />P.O. Box 349 <br />Florence, CO 81226 <br />(719)784-6325 <br />(7]9)784-3470 <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 <br />I ~~ G It ( ~~ ~ L t~ - <br />Signatur of C rporate Officer or Owner <br />~D ~/ Ci l <br />Date <br />A(: V'ERMnw1 ASTER DOCUM1tEMSUf-AF-01 <br />