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rvrr~u~- <br />i G -i3 ~~ <br />~~ C% <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />r/ ANNUAL FEE and REPORT REQUEST <br />li 13olcim (US) Inc. <br />~M-1977-345 <br />Boettcher Sand Stone Quarry <br />October 10, 2006 <br />aE~E~vE~ <br />~~~t ~, ~ ~Q~6 <br />~ "V1~fi~n~n9 a d Sa etY n, <br />$281.00 (Due on or before your anniversary date) <br />Lorimer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />- shall- sixbmit the annual fee, a report and map showing t7ie eztenf of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the urevious vear's map are necessarv, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Gordon Benton <br />Permittee Name: <br />Address: <br />Holcim (US) Inc. <br />Fort Collins Plant <br />P.O. Box 1548 <br />La Porte, CO 80535 <br />Phone Number: (970) 4$~6f5' a~o~ ~ g3 ~' 3 <br />Fax Number: (970) 48~-I.363 NIA <br />L <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or a hit to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signat a of Corporate Officer, Owner, or Designee <br />~~~/3/ e~ <br />Date <br />