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;~ <br />~: <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />CEMEX, Inc. fy' <br />~I-1977-361 <br />Silica Quarry <br />September 8, 2005 <br />~~,~~.r;..:.., <br />SEP 0 8 2005 <br />~~Divisinn of Minarets & GeoloBY <br />$251.00 (Due on or before your anniversary date) <br />Boulder <br />According to C.R.S. 34-32.5-1,16 or C.R.S. 34-32-116, each year, on the anniversary da*.e of the permit, an operator <br />shall. submit the annual fee,_ a repart_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 ynnr revised written anm~al rennrt and annnal re~nrt man to this form. Please note that an <br />adequately lnbeled map that clearly delineates and includes the above elements tnay suffice for a written report. <br />Division records indicate the following permi[tee 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 />Phone Number: <br />Fax Number: <br />Lyons, CO 80540 <br />X303) 823-2100 . <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 />-----'E-w'^ O ,~~ <br />Signature ofof Co~iporate Officer, Owner, or Designee <br />F/2 /o S <br />~~~~P~ <br />ANNiiAi, FF.F, and RF,PnRT RF.QiIF.ST <br />Date <br />