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i IIIIIIIIIIIIIIIIIII �r # Gsg \4 (OW &° <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Canyon Quarry Company RECEIVED <br /> PERMIT NO.: M-1977-376 JAN 19 2001 <br /> OPERATION NAME: Canon Dolomite Quarry <br /> Division of Minerals and Geology <br /> ANNIVERSARY DATE: September 22,2000 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: 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 <br /> operator 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 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 suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Gary W. Flanders <br /> Permittee Name: Canyon Quarry Company <br /> Address: <br /> p_2r�Z) crJ <br /> Colorado Springs, CO-809W (fnbroJc Sor;ke t C'b <br /> Phone Number: (719)-5%-7Nff- -7 19- 63 Y- I I a O <br /> Fax Number: (719) 635-2521 <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 <br /> enclosed. See re uerrc <br /> Signaftn-6 of Corporate Officer or Owner <br /> 1 - 19 - 01 <br /> Date <br /> M\PEPNiJrWASTERDOCUM1IENTSN-AF-01 <br />