2004-10-15_REPORT - M1977346

• Permit No: M1977346
• IBM Index Class Name: Report
• Doc Date: 10/15/2004
• Doc Name: Annual Fee/Report/Map
• From: Holcim ‎(US)‎ Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

.,,.

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Holcim (US) Inc.
M-1977-346
Boettcher Gypsum Quarry
October 10, 2004
,~ ~'
~~
OCT i 5 ?pp4
Division of Aq~ ;E,-, !s & CeotoBY
$688.00 (Due on or before your anniversary date)
Larimer
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to dale and during the preceding year, row disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed dw-ing the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ,~nnr revised written anneal rennrt and anneal rennrt man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report,
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Gordon Benton
Pennittee Name: Holcim (US) Inc.
Address:
Phone Number:
Fax Number:
Project Manager
P.O. Box 1548
La Porte, CO 80S3S
[phone]
{970)482-1363
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
Date