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iii iiiiiiiiiiiiiiii <br /> 999 <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> PERMITTEE NAME: Holnam, Inc. - Ft Collins Plant <br /> SEP 2 7 2001 <br /> PERMIT NO.: M-1977-345 Diyisi,tn of Minerals and Geology <br /> OPERATION NAME: Boettcher Sandstone Quarry <br /> ANNIVERSARY DATE: October 10,2001 <br /> ANNUAL FEE DUE: $281.00(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. Please note that an <br /> adequately labeled rnap that clearly delineates and includes the above elements may since fo,a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> PermitteeContact: Michael B.TOelle Britney L. Guggssberg <br /> Permittee Name: Holnam, Inc. -Ft Collins Plant <br /> Address: P.O. Box 1548 <br /> LaPorte, CO 80535 <br /> Phone Number: (970)482-4065 <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 /> 1 <br /> Signature of Corpor t Office or Owner <br /> c'1 —Z� - oI <br /> Date <br /> M:TER M fr1M ASTERDOCU St ENrS\M-AF-01 <br />