REP01091

• Permit No: M1987116
• IBM Index Class Name: Report
• Doc Date: 11/13/2003
• Doc Name: 2003 Annual Report and Fee
• From: Colorado Quarries Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNiiAi. FF,F. and RF,PnRT RF.niiF.ST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Colorado Quarries, Inc. /
M-1987-116
Siskin
November 2, 2003
$281.00 (Due on or before your anniversary date)
Custer
RECEIVED
~NOV 13 2003
i.
Division of Minerals and GeobgY
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
~s taR submr a annual Yee; ~rep~rt-and-map-showing-the-extent-of-eurrent-disturbances-te-affected-laAd,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach~nnr revised written anneal rennrt and anneal re nn rt m~ to his form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Bill Tezak
Permittee Name: Colorado Quarries, Inc.
Address: 270 S. 15th St.
Canon City, CO 81212
Phone Number: __ X19) 275-6894 _ ______ _ __ _ _
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Co orate Officer, Owner, or Designee
,e-may o~
Date
M:\PERM nVN ASTER DOC UM ENTSNI-A r-01