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999 <br /> � ( �z 3Us =) <br /> ANNUAL REPORT <br /> PERMITTEE NAME: Holnam, Inc. - Ft Collins Plant <br /> PERMIT NO.: M-1977-348 <br /> OPERATION NAME: Boettcher Quarry <br /> ANNIVERSARY DATE: October 10, 2000 , c <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $688.00 <br /> COUNTY: Larimer <br /> According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator shall <br /> 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 <br /> to occur during the upcoming year, reclamation that will be performed during the coming year, the <br /> dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised annual report map and written report to this annual report. Please <br /> note that an adequately labeled map that clearly delineates and includes the above elements may <br /> suffice for a written report. <br /> Please type or print the current contact person's name, mailing address, and phone number in the space <br /> provided: <br /> Contact Name: Britney Guggisberg Company: Holnam Tnr. <br /> Address: Fort Collins Plant Phone No.: ( 970 ) 482-4065 ext 297 <br /> P. 0. Box 1548 FAX No.: ( 970) 482-1363 <br /> LaPorte, CO 80535 e-mail: <br /> If there are additional comments and/or information that should be provided to the Division, please <br /> provide it on a separate sheet and attach it to this report form along with your map and/or written <br /> report. <br /> rgnature of Corpo to Officer, or Owner Date <br /> INSTRUCTIONS ON BACK <br /> M:�PERMfM,ASTERDOCUMENTSN-AF-01 / <br />