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-~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: CEMEX, Inc. <br />PERMIT NO.: M-1977-208 <br />OPERATION NAME: Lyons Quarry <br />ANNNERSARY DATE: September 8, 2002 <br />RECEIVED <br />SEP 0 9.2002 <br />~iuision of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 [he permit, an operator <br />_ shall submit the_annual_fee,_a_repon_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 [he upcoming year, reclamation that will be performed during the coming year, the dates for [he 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 report map to this form. Please note that an <br />adequately labeled map that clearly delineates arrd includes the above elements may 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 />Permittee Name <br />Address: <br />CEMEX, Inc. <br />P.O. Box 529 <br />Lyons, CO 80540 <br />Phone Number: (303) 823-2100 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to [he Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />°/- /-oZ- <br />Date <br /> <br />M9PERM ITUTASTERDOCUMEN'rSVN-AF-01 <br />