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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />f~/9il U~/ / /1~ 7, <br />ANNUAL FEE and REPORT REQUEST <br />y'7 Luis M. Vasquez <br />1/iCI-1999-064 <br />Lyon King Quarry <br />August 23, 2005 <br />RECEIVED <br />~NOV 1 0 2005 <br />Dieision of Minerals and Geofa9Y <br />$281,00 (Due on or before your anniversary date) <br />Lorimer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I16, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />L-land, rec amahon accbm`plislre~'TO d"ate and-during-the-preceding year, new-disturbances that are anticipated to _ _ __ <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note 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 />Permittee Contact: <br />Permittee Name: <br />Address <br />Phone Number; <br />Fax Number: <br />Abe Vasquez <br />Luis M. Vasquez <br />P.O. Box 122 <br />Lyons, CO 80540 <br />(303)823-6116 <br />(303)823-6888 <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 />S'gnature f Corporate Officer or Owner <br />Date <br />