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SEP-05-2008 09:26AM FROM-DIV RECLAMATION MINING & SAFETY +3038328106 <br />1 P--11' <br />ANNUAL FEE and EP REQUEST <br />PERMITTEE NAME: ACEMEX, Inc. <br />PERMIT NO.: I.A-1977-361 <br />OPERATION NAME: Silica Quarry <br />T-403 P.005/001 F-469 0 V-- <br />ANNIVERSARY DATE: September 8, 2008 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <br />P 08 2008 <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 report and annual report map to this form The Annual Report <br />& Fee requirement is not met until we have received the following components: fee re o and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary. then no new man is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Patrick Fischer <br />Perminee Namc: CEMEX, Inc. <br />Address: 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 the Division. please provide it <br />below o attach it t this form along with your written report and map. Annual Report instructions are enclosed. <br />y <br />V?F' Ao"' <br />Sfgnature Corporai6 Officer, Owner, r Designee <br />-T -7 0 U <br />Date