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ANNiiAI. FRF, and RF.PnRT RF.(IIIRST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Quarries, Inc. <br />M-1977-168 <br />Marrs Memorials <br />November 30, 2003 <br />NOV 2 5 20~ <br />pivision of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Fremont <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 ex[ent_of_current_disturbances_to_af£ec[ed_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 rennrf and anneal re~nrt m ~n to this form- Please note that an <br />adequate/y 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: Sill Tezak <br />Permittee Name: Colorado Quarries, Inc. <br />Address: <br />Phone Number: <br />Fax Nurnber: <br />270 S. 15th St. <br />Canon Ciry, CO 81212 <br />(719) 275-6894 <br />(719)275-2131 i <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 />c <br />Si nature of C rate Officer, Owner, or Designee <br />~ d - ~ -o ~ <br />Date <br />~d Ck~r y~ ~Gr t s /t~~'~- ~" <br />M9PERMITN1ASTFRDOCUMENTSUI-AF-01 <br />