2009-10-13_REPORT - M1977346

• Permit No: M1977346
• IBM Index Class Name: REPORT
• Doc Date: 10/13/2009
• Doc Name: Annual Fee/Report/Map
• From: Holcim
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
i
US
I
PERMITTEE NAME: Holc
m (
)
nc.
PERMIT NO.: ?M-1977-346
OPERATION NAME: Boettcher Gypsum Quarry
ANNIVERSARY DATE: October 10, 2009
ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date)
COUNTY: Larimer
OCT t?_'
C13 609
DiviWen at reclamation,
Ting and Safety
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 annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous vear's map are necessarv, then no new map is required, provided that the Operator shall state
this in the Annual Report. 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: Michael B. Toelle
Permittee Name
Address:
Phone Number:
Fax Number:
If you
below
Holcim (US) Inc.
3500 Highway 120
Florence, CO 81226
[phone]
[phone]
ional comments and/or information that should be provided to the Division, please provide it
to this form along with your written report and map. Annual Report instructions are enclosed.
Officer, Owner, or Designee
Date