2004-10-15_REPORT - M1977345

• Permit No: M1977345
• 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

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Holcim (US) Inc.
M-1977-345
Boettcher Sand Stone Quarry
October 10, 2004
~ri:~nu:~~f~~
OCT i 5 2004
Oivisiea of h5iaerats & Geology
$281.00 (Due on or before your anniversary date)
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,
rcclan-.afros accomplished to catP and during the preceding year, new- disturbances That are anticipated to occar
duiiug the cpr~r_~iing y~:+i~'re.:~•-~~~ o=+ that viii be performed during the comi~~g year, the. dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attachyonr revised written anneal report and anneal report map M this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice jor a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Perrnittee Name:
Address:
Gordon Benton
Holcim (IJS) Inc.
Fort Collins Plant
P.O. Box 1548
La Porte, CO 80535
Phone Number: [phone]
Fax Number: (970)/.j p;2a1363
0„"° N /
Q 70 - ~8~ _ i,~G,3
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