2017-09-08_REPORT - M1993041

• Permit No: M1993041
• IBM Index Class Name: REPORT
• Doc Date: 9/8/2017
• Doc Name: Annual Fee/Report/Map
• From: CEMEX, Inc.
• To: DRMS
• Annual Report Year: 2016
• Email Name: AME
• Media Type: D
• Archive: No

g Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Bradley S. Wilson
Permittee Company: CEMEX, Inc.
Address: PO Box 529
Lyons,Co 80540
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: John Lohr
Company: CEMEX, Inc.
Address: P.O.Box 529
Lyons,CO 80540
Phone Number: [phone]
Fax Number:
Email Address:
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Inspection Contact: John Lohr
Company: CEMEX, Inc.
Address: P.O. Box 529
Lyons,CO 80540
Phone Number: [phone]
Fax Number:
Email Address:
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I,the undersigned,hereby state at e,information provided in this report is,true and accurate, and that site operations are
being con du in accordanc wi the Division a roved mining and reclamation plans.
sianituA of Pe itt Cor orate Officer, ner,or Documented Designee Date