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PERMITTEE NAME: 4'Holcim (US) Inc. <br />PERMIT NO.: 11-1977 -347 <br />OPERATION NAME: Slab Canyon Quarry <br />ANNIVERSARY DATE: October 10, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date <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 accomplished 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: Holcim (US) Inc. <br />Address: 3500 Highway 120 <br />Phone Number: <br />Fax Number: <br />If y <br />belo <br />Date <br />ao■/ /u <br />Florence, CO 81226 <br />(719) 484 -1402 <br />(719) 784 -3470 <br />ave additional comments and /or information that should be provided to the Division, please provide it <br />it to this form along with your written report and map. Annual Report instructions are enclosed. <br />dr <br />AINIn uAL FEE' and PORT REQUEST <br />Signat re of Corporate Officer, Owner, or Designee <br />