2005-09-30_REPORT - M1993041

• Permit No: M1993041
• 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

.,~ S G
a~F~f~~
ANNFJAL FEE and REPORT RR.(1IIF,ST
PERMfTTEE NAME: C/EMEX, Inc.
PERMIT NO.: YM-1993-041 CEP 3 U 2005
OPGRAT[ON NAME: Dowe Flats Mine ~ tliul4l0a of lU"incrala$~ppa$~
ANNIVERSARY DATE: September 8, 2005
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY: Boulder
According to C.R.S. 34-32.5-! l6 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator
shall submit the annual tee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occuc
during [he upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach~nnr revised written anneal report and anneal rennrt map to this form. Please note that an
adequately labeled reap that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Ptease verify and make any necessary
changes:
Permittee Contact: John Lohr
Permittee Name: CEMEX, (nc.
Address: P.O. Box 529
Phone Number:
Fax Number:
Lyons, CO 80540
[phone]
[f 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