2015-09-08_REPORT - M1977208

• Permit No: M1977208
• IBM Index Class Name: REPORT
• Doc Date: 9/8/2015
• Doc Name: Annual Fee, Report & Map
• From: Cemex
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
BradleyS. Wilson
Permittee Company:
CEMEX
Address:
PO Box 529
Lyons,Co80540
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
Brad] eys.wiIson(a cemex.com
I, the undersigned, hereby state that the inf ation provided in this report is true and accurate, and that site operations are
being conduc�ordance with the Yision approved minnd reclamation plans.
S
M -AF -01
Owner,
Date