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<br />PERMITTEE NAME: Holcim (US) Inc. _ <br />~ <br />PERMIT NO.: M-1977-346 ~~~~~L(~1) <br />OPERATION NAME: Boettcher Gypsum Quarry Q~r ®~ ~Q~ <br />ANNIVERSARY DATE: October 10, 2003 <br />uayi <br />i <br /> s on otMiaarals and Geology <br />ANNUAL FEE DUE: $688.00 (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 submii the annual fee,-a iepor~and map showing-the extent'of-current disrurbances-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 />PI as at arh Ynnr revised written annul red nrt and annaal red nrt ma; to this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suj~ce for a written report. <br />Division records indicate the following pertnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gordon Benton , project Manaqer <br />Permittee Name: <br />Address: <br />Phone Number: <br />Holcim (US) Inc. <br />P.O. Box 1548 <br />La Porte, CO 80535 <br />970-482-4065 x229 <br />Fax Number: 970-482-1363 <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 />6,1~~ <br />Signaru e of Corporate Officer, Owner, or Designee <br />/~/~/ v '~ <br />Date <br />M:\PERMITUTASTERDOCUMENTS\M-AF-01 <br />