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ANNUAL FEE and REPORT REQUEST <br />Colorado Quarries, Inc. <br />M-1982-200 <br />Red Jasper Granite <br />November 19, 2002 <br />NOV 0 8 2002 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />RECE9VLD <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Teller <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on [he anniversary date of the permit, an operator <br />shall submit the annual _fee, a _report_ and m_ap showing_ the extent of current disturbances 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 />Please attach vour revised written annual report and annua! report map to this form. Please note that an <br />adegnately Labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Tezak <br />Permittee Name: Colorado Quarries, Inc. <br />Address: 270 S. 15th St. <br />Canon City, CO 81212 <br />Phone Number: (719) 275-6894 <br />Fax Number: (719) 275-2131 <br />If you have additional comments and/or information that should be provided [o 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 />~.~ ~ <br />Signature of orporate Officer, Owner, or Designee <br />Io- /D -vL <br />Date <br />Nth /t~C'G~-~' <br />EGtet-mot y G•'3 <br />/~" <br />~-ti is S~ ~~ <br />M:~PERM ITU4ASTERD000M ENTSVN-AF-OI <br />