2003-10-14_REPORT - M1977344

• Permit No: M1977344
• IBM Index Class Name: Report
• Doc Date: 10/14/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

V

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Hoicim (US) Inc.
M-1977-344
Portland Limestone Quarry
October 10, 2003
~CT 1 '1 ~®~~
Division of Mine~afs and GeolopN
$688.00 (Due on or before your anniversary date)
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
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 ynnr revised written annual rennrt and anm~al re~nrt m ~n to this form- 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 perrnittee contact information. Please verify and make any necessary
changes:
Permittee Contact: -A Mtt.41GZ~
Permittee Name:
Address:
Phone Number:
Fax Number:
Holcim (US) Inc.
3500 Hwy. 120
Florence, CO 81226
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it [o this form along with your written report and map. Annual Report instructions are enclosed.
Signature of C rp rate Officer, Owner, or Designee
~o%a/© ~
Date `'~
M:~PERM INNASTERDOCUMENTSUI-AF-01