2005-09-30_REPORT - M1977208

• Permit No: M1977208
• IBM Index Class Name: Report
• Doc Date: 9/30/2005
• Doc Name: Annual Fee/Report/Map
• From: CEMEX Inc
• To: DMG
• Media Type: D
• Archive: No

PERM[TTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL EEE DUE:
COUNTY:
CEMEX, Inc.
M-1977-208
Lyons Quarry
September 8, 2005
$688.00 {Due on or before your anniversary date)
Boulder
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
shalt submit the annual fee, a report and map showing the extent of cutient disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during [he upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning
of active operations, and [he date active operations ceased for the year, if any.
Please attach ynnr revised written anneal rennrt and anneal rennrt map to fhic form- Please-note [ha[ an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: John Lohr
Permittee Name: CEMEX, Inc.
Address: P.O. Box S29
Phone Number:
Eax Number:
Lyons, CO 80540
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
Date