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t. <br />~~ ~- ~1 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE UEST <br />Holcim (US) Inc. <br />M-1977-247 <br />Coaldale Quarry <br />~~~~~~® <br />APR 0 7 2008 <br />Division of Reclamation, <br />Mining and Safiety <br />April 28, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <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 annuial 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~he 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 your 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 />ma If no new disturbances or reclamation have occurred during the previous year and no new changes 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Michael B. Toelle <br />Permittee Name: <br />Address: <br />H[olcim (US) Inc. <br />3500 Highway 120 <br />Florence, CO 81226 <br />Phone Number: ('719) 784-6325 <br />Fax Number: ('719) 784-3470 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />cc.ti . !-~ <br />'gnature of CorporatE: fficer, Owner, or Designee <br />i~<~~ ~~. Z~ 8 <br />Date <br />