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SEP-O6-200T 10:2TAM FROM-DIV RECLAMATION MINING & SAFETY 3036328102 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AP ~r iL~ <br />ANNUAL FEE an(d~R'EPORT REQUEST <br />CEMEX, Inc. r+~/ <br />M-1977-3ti1 n/ <br />Silica Quarry <br />September 8, 2007 <br />T-106 P.006/010 F-251 n <br />RECENED / <br />SEP 17 2001 / ~ <br />Division of RerAamatlon, <br />Mining and Safety <br />$$323.00 (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 aze 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 voar revised written annual report and annnal report map to this form. The Annnal Report <br />.4c Fee requirement is not met until We have received the following components: fee, report, and associated <br />IDBD. If no new disturbances or reclamation have occurred during the previous vear and no new chaaQes to <br />the orevious year's map are necessary, then no new map is repaired, provided that the Oocrator shall state <br />this in the Annual Report. Please note that an adequately labeled neap drat clearly delineates and includes tfre <br />above elements may since for a written report. <br />Division records indicate the following permittec 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 Ntmtber: <br />CL•MEX, Inc. <br />P.O. Box 529 <br />Lyons, CO 80540 <br />(303)823-2100 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />Si ature of Corporate Officer, er, or Desigttce <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />Datr <br />