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III IIIIIIIIIIIII III ~ ~ g a~7 <br />ANNUAL REPORT <br />PERMTl"TEE NAME: Holnam, Inc. - Ft Collins Plant <br />PERMIT NO.: M-1977-345 <br />OPERATION NAME: Boettcher Sandstone Quarry - ~° ~ ' ~' ~''~ <br />ANNIVERSARY DATE: October 1Q 2000 ~rT ~ c . •r. <br />c.,~ <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $281.00 ~ ., , ,` . ,; I `c , 'Y <br />COUNTY: Latimer <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 aze anticipated <br />to occur during the upcoming yeaz, reclamation that will be performed during the coming yeaz, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised annual resort map and written resort to this annual resort. Please <br />note that an adequately labeled map that clearly delineates and includes the above ela~ments may <br />since for n 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: Britnev Guct4isberct <br />Address: Fo Col l inc pl nt <br />P. O. Box 1548 <br />LaPorte, CO 80535 <br />Company: Holnam. Inc. <br />Phone No.:( 970 ) 482-4065 Pxt. 297 <br />FAX No.: ( 970) 482-1363 <br />e-mail: <br />If there aze 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 />~--*-~ / c°.C~ c~-2.C ,:.% r'7A-~'i- ACS ~/Ct ~CTU _ <br />ignature of Corp rate Officer, or Owner Date <br />/NSTRUCT/ONS ON BACK <br />M ~PERMIIV.fASTERD000MEtlfSUi-AF01 <br />