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• <br />ANNUAL REPORT <br />PERMITTEE NAME: Tezak Heavy Equipment Co. Inc. <br />PERMIT NO.: M-77-193 <br />OPERATION NAME: T.H.E. Aggregate Source <br />ANNNERSARY DATE: November 22, 1999 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 <br />COUNTY: Fremont <br />• I I IIIIIIIIIIIII III <br />999 <br />1'~1-111 <br />RECEIVED <br />~r~r, o ~ 2oa~ <br />Division of Mite%ta~ ~ Geology <br />according ro C.P..S. 34-32.5-116(3)(a), each year, on the arnivers.~try date c£ the permi°, an operaror <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are <br />anticipated to occur during the upcoming year, reclamation that will be performed during the coming <br />year, the dates for the beginning of active operations, and the date active operations ceased for the year, <br />if any. <br />Please attach your revised annual report map and written report to this annual report. P/ease <br />note that mi adequately labeled map That clearly delineates and includes the above e[eme~tts may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contac[Name: Daniel E. Tezak Company: Tezak Heavy Equipment Co., Inc. <br />Adddress: 201 Tunnel Drive Phone No.: (719) 269-1173 <br />anon ity, <br />Fax No.: (719) 269-1148 <br />If there are additional comments and/or information [hat should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report fotm along with your map and/~~r written <br />report. <br />~J o~.,.~-~ ~'T~,-~- I - o s - c3o <br />Signature of Corporate Officer, or Owner Date <br />INSTRUCT/ONS ON BACK <br />