2010-04-23_REPORT - M1977247 (3)

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Is IL AO, 10 ANNUAL FA and REPORT REQUEST PERMITTEE NAME: olcim (US) Inc. APR 2 3 2010 PERMIT NO.: M-1977-247 Divkjon ct KscW?esiim, OPERATION NAME: Coaldale Quarry / Mining and Safety ANNIVERSARY DATE: April 28, 2010 ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) COUNTY: Fremont 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 may 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 year's may are necessary, then no new may 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: Joe Lamanna Permittee Name: Holcim (US) Inc. Address 3500 Highway 120 Florence, CO 81226 Phone Number: (719) 784-6325 Fax Number: (719) 784-3470 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. Si ature of orporate Officer, Owner, or Designee y/.? /a Date