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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Southwestero Portland Cement <br />M•1993.041 <br />Dowe Flats Mine <br />September 8, 2001 <br />$688.00 (Due on or before your anniversary date) <br />Boulder <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of [he permit, an operator <br />shall submit the annual fee, a report and map showing the extent of curtent'disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date. active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately, labeled map that clearly delineates and includes the above elements may suffice for a writen report. <br />Division records indicate the followine oermittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John Lohr <br />Permittee Name: Southwestern Portland Cement <br />Address: P.O. Box 529 <br />Lyons, CO 80540 <br />Phone Number: (303) 823-2109 <br />Fax Number: (303) 823-2199 <br />-If you have additional comments-and/or information that should 'be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed. <br />M:WERMmN1ASfERD000MEM'S~M-AF-01 <br />