2004-09-13_REPORT - M1977361

• Permit No: M1977361
• IBM Index Class Name: Report
• Doc Date: 9/13/2004
• Doc Name: Annual Fee/Report/Map
• From: CEMEX Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

F°
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
CEMEX, Inc.
M-1977-361
Silica Quarry
September 8, 2004

RE~Ei~!E®
SEI 13 2004
Uivisioit of Minerals & GeoloAY
$281.00 (Due on or before your anniversary date)
Boulder
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_~ccgZding to C.R.S _34-3.2_.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 fo affected land;
reclamation 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 ypnr revised written annual rennrt and annual re nrt maTtn 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
Lyons, CO 80540
Phone Number: [phone] - - -- " - -
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.
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Signature of Corporate Officer, Owner, or Designee
Date