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ANNUAL FEE and REPORT REQUEST <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator <br />shall Fyymi the_annual_.fee, axeporc-and--map-showing-the--extent--ef-eutrent~disturbances-to-affected tagd; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, 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 vour revised written annual report and annual resort man to this form. Please Wore chat an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John Lohr <br />Permittee Name: CEMEX, Inc. <br />Address: P.O. Box 529 <br />Lyons, CO 80540 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />CEMEX, Int. <br />M-1993.041 <br />Dowe Flats Mine <br />September 8, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Boulder <br />Phone Number: (3031 R23-2100 <br />Fax Number: <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 instructions are enclosed. <br />i <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />MIPERMrnMASTERDOCUMEM5N1-AFA I <br />