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V <br />~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />CEMEX, Inc. <br />M-1993-041 <br />Dowe Flats Mine <br />September 8, 2003 <br />RECEIVED <br />SEP 0 5 2003 <br />Division ~f Minerals and Geobsfy <br />$688.00 (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 [o 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 ynnr revised written anneal report and anneal report main to this form. Please Hole that an <br />adequately labeled map that clearly delineates and 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: CEMEX, Inc. <br />Address: P.O. Box 529 <br />Phone Number: <br />Fax Number: <br />Lyons, CO 80540 <br />(303)823-2100 <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 />of Corporate Officer, Owner, or Designee <br />• <br />MiPERM ITUTASTERDOCUMENTS~h1-AF-01 <br />