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<br /> <br /> <br />PERMITI,EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Aolnam, Inc. - Ft Collins Plant <br />M-1977`34 34 g <br />Boettcher Quarry <br />October 10, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Lorimer <br />OCT 0 3 2002 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-1 1 6 or C.R.S. 34-32-1 16, each yeaz, 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, reclamation <br />accomplished to date and during the preceding yeaz, new disturbances that are anticipated to occur during the <br />upcoming year, reclamation that will be perfonned during the coming year, the dates for the beginning of active <br />operations, and the date active operations ceased for the year, if any. <br />Please attach Your revised written annual report and annual report maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following pemrittee contact information. Please verify and make any necessary changes: <br />Perrnittee Contact: Britney Guggisberg <br />Permittee Name; Holnam, Inc. - Ft Collins Plant <br />Address: P.O. Box 1548 <br />LaPorte, CO 80535 <br />Phone Number: (970) 482-4065 <br />Fax Number: (970) 482-1363 <br />Roy 1« Stienmier <br />Aolcim (US) Inc. <br />P.O. Box 1468 <br />LaPorte, CO 80535 <br />(970) 482-5600 <br />(970) 482-5608 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />