2004-10-15_REPORT - M1977347

• Permit No: M1977347
• IBM Index Class Name: Report
• Doc Date: 10/15/2004
• Doc Name: Annual Fee/Report/Map
• From: Holcim ‎(US)‎ Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

:~
~~

YYY~~~ ANNiiAi. FF.F, and RF.Pt7RT RFOiiF.fiT
'~G.: t
\ ~ ~~®
PERMITTEE NAME: Holcim (US) Inc. ~~j ~ 5 ~QO

PERMIT NO.:
OPERATION NAME: 4
M-1977-347 ~i:'isicu at Adi ,r; z!s ~ geolor
Slab Canyon Quarry
ANNNERSARY DATE: October 10, 2004
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY: Larimer
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
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 disiurbances that arc anticipated to cccur
during the upcoming year, recian:at; ~n that will be per."armed daring the coming year, the dates for the hegi.^.ring
of active operations, and the date active operations ceased for the year, if any.
Please attachynnr revised written anneal rennrt and anm~al renort maT to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may su]~ce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Gordon Benton
Permittee Name: Holcim (US) Inc.
Address: Project Manager
P.O. Box 1548
La Porte, CO 80S3S
Phone Number: [phone]
Fax Number: [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.
Signature of Corporate Officer, Owner, or Designee
Date