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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNJVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />CEMEX, Ioc. <br />M-1993-041 <br />Dowe Plats Mine <br />September 8, 2003 <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 year, on the anniversary date of the permit, an operator <br />shah submit-the anmsal €ee, a report and map-showing the extent of current 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 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 your revised written anneal rp~nrt and annual re~nrF map,jn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since jor 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 />Petmittee Name: CEMEX, Inc. <br />Address: P.O. Box 529 <br />Phone Number: <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 />of Corporate Officer, Owner, or <br />Lyons, CO 80540 <br />(303)823-2100 <br />M:IPERMITUTASTERD000MENTS@A-AF-0I <br />