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PERMITTEE NAME: <br />PERMTf NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Holcim (US) Inc. <br />M-1977-348 <br />Boettcher Limestone Quarry <br />October 10, 2007 <br />RECEIVED <br />OCT 0 5 2007 <br />Division of Reclamation, 1,~ <br />Mlning and Safety <br />$$791.00 (Due on or before your anniversary date) <br />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 Yo 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 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 />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary, 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 suj~ce for a written report. <br />Division?cords indicate [he following permitteorcontact information. Please verify and make any~'iecessary <br />changes: , , ~' <br />~ ; ,• r" <br />Permitteeontact: Gordon Benton r. $s <br />Permittee Name: Holcim (US) Inc. <br />Address: Project Manager <br />P.O. Box 1548 <br />La Porte, CO 80535 <br />Phone Number: (970) 222-8353 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />~0/3/.7a~7 <br />Date <br />