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-~ ~ Ci <br />+~ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: /Holcim (US) Inc. RECE~VE~ <br />PERMIT NO.: ~M-1977-346 j nCT (? ~ ~~~s <br />OPERATION NAME: Boettcher Gypsum Quarry division of Reclamation, <br />Mining and Safety <br />ANNIVERSARY DATE: October 10, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br />iy~~jL <br />/U -(3-Z~ <br />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 <br />shall'sabmit 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 vour revised written annual report and annual report man 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 durinti the previous year and no new chanties to <br />the previous year's mac are necessary, then no new mac is required, provided that the Operator 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gordon Benton <br />Permittee Name: Holcim (US} Inc. <br />Address: Project Manager <br />P.O. Box 1548 <br />La Porte, CO 80535 <br />- ~S-~3~3 <br />e Number: (970) ~, <br />Fax Number: (970) 482-13f3'-vJ1~ <br />If you have additional <br />below or attach i~gRhi <br />and/or information that should be provided to the Division, please provide it <br />with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate~fficer, Owner, or Designee <br />Date <br />