2004-09-02_REPORT - M1977208

• Permit No: M1977208
• IBM Index Class Name: Report
• Doc Date: 9/2/2004
• Doc Name: Annual Fee/Report/Map
• From: CEMEX Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

• ANNiiAi, FF.F, and RF.PnRT RF.OiiF.ST
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
CEMEX, Inc.
M-1977-208
Lyons Quarry
September 8, 2004
$688.00 (Due on or before your anniversary date)
Boulder
RECEIilEI~
SEP 0 2 2004
Division o1 Mii,_:als & Geology
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamapon_accomplished_to_date and during_the_preceding year, new disturbances that-are anticipated to occur
during the 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 ynnr revised written annual report artd annual rernrt main M this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffzce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
• Permittee Contact: John Lohr
Permittee Name:
Address:
Phone Number:
Fax Number:
CEMEX, Inc.
P.O. Box 529
Lyons, CO 80540
[phone]
If you have additional comments and/or information that should be provided to the Di~~sion, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
~-
of Corporate Officer, Owner, or Designee
•