2011-09-26_REPORT - M1977345 - Laserfiche WebLink

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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: 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 year's map are necessary, 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: Holcim (US) Inc. Address: 3500 Highway 120 Florence, CO 81226 Phone Number: (719) 784 -1402 Fax umber: (719) 784 -3470 GI Signa ure Corporate Officer, Owner, or Designee Date A-f ANNUAL FEE a REPORT REQUEST olcim (US) Inc. - 1977 -345 Boettcher Sand Stone Quarry October 10, 2011 $$323.00. (Due on or before your anniversary date) Larimer If y ave additional comments and /or information that should be provided to the Division, please provide it belo •^ .4 h it to this form along with your written report and map. Annual Report instructions are enclosed.