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.~ <br />~~ ~-~~ <br />ANNUAL FEE and REPORT REQUEST <br /> ~ RECEIVED <br />PERMITTEE NAME: xolcim (ilS) Inc. / <br />PERMIT NO.: M-1977-346 ~ OCT 0 5 2007 v <br />OPERATION NAME: Boettcher Gypsum Quarry Division of Reclamation, <br /> Mining and Safety <br />ANNIVERSARY DATE: October 10, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 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 />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map are necessary, then no new man 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 suffice 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: <br />Address: <br />Holcim (US) Inc. <br />Project Manager <br />P.O. Bax 1548 <br />La Porte, CO 80535 <br />Phone Number: (970) 222-8353 <br />~~~ <br />Pdt VJ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or atta 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 />~0 <br /> <br />Date <br />