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9`~ <br />~~.~-R4~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE VEST <br />Hoicim (US) Inc. <br />M-1977-345 <br />Boettcher Sand Stone Quarry <br />October 10, 2007 <br />$$323,00 (Due on or before your anniversa <br />Lorimer <br />RECEIVED <br />OCT 0 5 2001 / ~ <br />and Safety n, ~?`... <br />~~~ ~ <br />ry date) O <br />(\ <br />~~ <br />D' <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-shaa~ng the extent of cunenY 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 durinc the previous year and no new chances 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gordon Benton <br />Permittee Name: <br />Address: <br />Hoicim (US) Inc. <br />Fort Collins Plant <br />P.O. Box 1548 <br />La Porte, CO 80535 <br />Phone Number; (970) 482-4065 <br />If you have additional comments and/or information that should be <br />below or attac 't to this form along with your written report and map. <br />Signature of Corporate Officer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br /> <br />N <br />l0-3 ~ ~~ <br />Date <br />