2005-09-29_REPORT - M1977345

• Permit No: M1977345
• IBM Index Class Name: Report
• Doc Date: 9/29/2005
• Doc Name: Annual Fee/Report/Map
• From: Holcim ‎(US)‎ Inc.
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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ANN1iAi. FF.F, and RF.PnRT RI
~Icim (US) Inc.
~/M-1977-345
Boettcher Sand Stone Quarry
October 10, 2005
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SEP 2 ~ 2GU5

$281.00 (Due on or before your anniversary date)
Lorimer
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 date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annnal rennrt and annual rennrt m~ 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
Permittee Name: Holcim (iJS) Inc.
Address: Fort Collins Plant
P.O. Box 1548
Phone Number:
Fax Number:
La Porte, CO 80535
[phone]
(970) $4'L-1363
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C97v) ~8a-/363
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach i[ to this form along with your written report and map. Annual Report instructions are enclosed.
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Signature of Corporate Officer, Owner, or Designee
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