2003-09-05_REPORT - M1977208

• Permit No: M1977208
• IBM Index Class Name: Report
• Doc Date: 9/5/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
SEP 0 5 2003
ANNIIAi, FF.F and RFPnRT RRniJF,ST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
CEMEX, Inc.
M-1977-208
Lyous Quarry
September 8, 2003
$688.00 (Due on or before your anniversary date)
Boulder
Division of Minerals and Geobsy
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_atmuaLfee,_a_report_and_map_showing_the extent_of_current_disturbances-to-affected-land, - - -
reclamation accomplished io 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 anneal report and anneal rennrt m~ to this form- please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice 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: CEMEX, Inc.
Address: P.O. Box 529
Phone Number:
Fax Number:
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.

of Corporate Officer, Owner, or Designee
•
Lyons, CO 80540
[phone]
M1PERM17VNASTER000UMENTSU~I-AF-01