2015-09-08_REPORT - M1993041

• Permit No: M1993041
• 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:
[e-mail]
I, the undersigned, hereby state that the
being conductSd-iu accordance with the
�x
Signatu
M -AF -01
on provided in this report is true and accurate, and that site operations are
approved mining and reclamation plans.
Documented Designee
-� 4015
Date