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12i30i2003 09:14 <br />< \^/ <br />COLORRDO QURRRIES a 13038328106 N0.903 D04 <br />/ ~~IIAI~ FF,F, and RFP(~RT,~(~jjEST''~ ' ., ii'~ it <br />pERM111'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL E'EE DUE: <br />COUNTY: <br />`Colorado Quarries, Inc. <br />,~ M-1987-116 <br />Slsltin <br />November 2, 2003 <br />$261.00 (Due on or before your anniversary date) <br />Custer <br />~w~w ~ ~ T003 <br />Division of Minerals anq Geolo9Y <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, ench year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a repot[ and map showing the extent of current disntrbances to affected land, <br />reclamation accomplished [o 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 />PlgacP afYarh y,4ur r VICPd WrirtPn Annllflj„~(~,rnrt $hd annual re rnn t mnp,t~,t ie tnrn,_ Please Wore that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: Bi~l Terak <br />,.. . <br />Perminee Name: Colorado Quarries, lnc. <br />Address: 270 S. ]5th 5t. <br />Canon Ciry, CO 81212 <br />Phone Number: {719) 275.6894 <br />Fax Number: (7(9) 275-2131 <br />]f ynu have, additions! comments and/or information that should be provided to the Division, please provide it <br />below or a[tach it to this farm along with your written report and map. Annual Report instructions are enclosed, <br />~-•[.C~ <br />Signsture of Co orate Officer, Owrter, or Designee <br />i U - ~~-D 3 <br />Date <br /> <br />