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e511.4-1 <br /> @C S <br /> <br /> rALEE and REPORT REQUEST <br /> <br />PERMITTEE NAME: ?Uolcim (US) Inc. <br />PERMIT NO.: ?M-1977-348 ti r ~ <br /> ? <br />OPERATION NAME: Boettcher Limestone Quarry <br /> <br />s 4 Rv?. <br />G j <br /> <br />ANNIVERSARY DATE: October 10, 2010 <br /> 4 v:!"71 a <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) _":."' ,.':•.;i <br />COUNTY: 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 to affected land, <br />reclamation-accompli-shed-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 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 />map. 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 />Holcim (US) Inc. <br />3500 Highway 120 <br />Florence, CO 81226 <br />Phone Number: (719) 784-1402 <br />Fax Ii nber: (719) 784-3470 <br />If yo h dditional comments and/or information that should be provided to the Division, please provide it <br />belo or it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signatu? of Corporate Officer, Owner, or Designee <br />Ci Aa <br />Date