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~Ga <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUN'T'Y: <br />I/ ANNUAL FEE and REPORT REQUEST <br />r//Colorado Quarries, Inc. <br />/ M-1987-027 <br />Hardship Lode Quarry <br />November 6, 2006 <br />~.~rt, <br />to d'f "O~ <br />~~~~~~~D <br />acT z a zoas <br />division of Reclamation, <br />tinning and Safety <br />$281.00 (Due on or before your anniversary date) <br />Custer <br />According to C.R.S. 3432.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />- -dunn'g a upcoming year, rec amation tthat will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for [he year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Anuual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: 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 <br />below or attach it to this form along with your written report and map. <br />C <br />Signature of Co orate Officer, Owner, or Designee <br />~C~--~~ <br />Date <br />Tel ~ S ~e''f~lnt c 1 iv <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />~2~~~5 S~ <br />o ~ b ~« y ~ <br />ion v~~~-~ ~~ /1 ~ <br />