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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />CEMEX, Inc. <br />M-1977-208 <br />Lyons Quarry <br />September 8, 2006 <br />RECEIVED <br />SEP 0 5 2p06 <br />~ ~R <br />M3 ~ndS <br />$688.00 (Due on or before your anniversary date) <br />Boulder <br />~~~ <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator <br />_ shall submit the_ annual fee, 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 annual report and annual report mao to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />Buff ce 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 />Pa+r~cl< ~ISchel' r/ <br />Lyons, CO 80540 <br />Phone Number: (303) 823-2100 <br />Fax Number: ~3 0 3- °6 Z 3• Z 1 9 q <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />