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qcs <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE an REPORT VEST <br />CEMEX, Inc. <br />1--'M-1977-361 <br />Silica Quarry <br />September 8, 2010 <br />$$323.00 (Due on or before your anniversary date) <br />Boulder <br />A?, <br />00t%Q%1. <br />` ;:^ otY <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 accant-ptrg re?d-to-date-and-during -the-preceding-year-,new-di tur?bances -antto 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 your 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, report, 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 map 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Patrick Fischer <br />Permittee Name <br />Address <br />Phone Number: <br />Fax: Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Date <br />CEMEX, Inc. <br />P.O. Box 529 <br />Lyons, CO 80540 <br />(303) 823-2100 <br />