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C.J <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Hector Rodriquez <br />M-1999-062 <br />Indio Red Quarry Number 1 & 2 <br />August 23, 2002 <br />RECEIVED <br />AUG 16 yppZ <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Larimer <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 affec[ed_land, _ <br />reclamation accomp]ished to date and during the preceding yeaz, 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 vour revised written annual resort and annual reuort mau to this form. Please note 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: Hector Rodriquez <br />Permittee Name: Hector Rodriquez <br />Address: P.O. Box 1504 <br />Lyons, CO 80540 <br />Phone Number: (303) 823-6452 <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 />Signature of Corporate Officer or Owner <br />Date <br />M 1PERM77 VNASTERDOCUMENTSVN-AF-01 <br />