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v <br />ANNiJAi, FFF. and RFPnRT RF,OiTF,ST <br />~~ RECEAVED <br />PERMITTEE NAME: Luis M. Vasquez JUL 212004 <br />PERMIT NO.: M-1999-063 Division at Minerals & Genlopy <br />OPERATION NAME: Red Wolf Quarry <br />ANNNERSARY DATE: August 23, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />-----reclamatior, uccorr:plished-to-date-ard-3cring-the~recedisrgyear,-tre~Ttlisturbances thai are anricipafed"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 ynnr revised written annual rennrt and annual rennrt main to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: ` / <br />Permittee Contact: Luis M. Vasquez ~~~ V Ct S 9rJe-~ <br />Permittee Name: Luis M. Vasquez <br />Address: P.O. Box 122 <br />Lyons, CO 80540 n /'` <br />Phone Number: (303) 775-6890 ~ (~~ ~ d~ ~ ~ - `(~ (~ `~~ <br />Fax Number: 3D7- g 2~ - 6~u~ <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 />Signature of Corporate Officer, Owner, or Designee <br />~ Iy-~y <br />Date <br />