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~a-ia <br />~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />v ANNUAL FEE and REPORT REQUEST <br />/ Holcim (US) Inc. RECENED <br />~M-1977-347 ~ ~ (1Fi'~6 <br />Slab Canyon Quarry ~~ of li ' <br />October 10, 2006 ~~~ end SAY <br />$688.00 (Due on or before your anniversary date) <br />Lorimer <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 yeaz, 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 resort 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 />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's moo 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 far 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 />Phone Number: (970) 48i~663 ~(~~ _~ 353 <br />Fax Number: (970) 4363 N ~ ~ <br />>/ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or att~h it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Sign~t'irre of Corporate Officer, Owner, or Designee <br />JD `.j -~~ <br />Date <br />