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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, lne. RECEIVED <br />~M-1977-361 ~ SEP 0 5 2006 <br />Silica Quarry ~ ivision of Reclamation. <br />Mining and Safety <br />September 8, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Boulder <br />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 <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 vour revised written annual resort and annual resort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, 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 />suffice 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 />Pennittee Name: CEMEX, Inc. <br />Address: P.O. Box 529 <br />Phone Number: <br />Fax Number: <br />Lyons, CO 80540 <br />(303) 823-2100 <br />i7a-}~tcf~ ~scf2.e,~- t/ <br />If you have additional comments and/or information that should be provided to the Division, please provide <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 />