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ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Marble, L.L.C. <br />M-1987-028 <br />Lily Mines <br />March 18, 2002 <br />MAR 1 4 2002 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Chaffee <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 />recfama-tion-accan~plished to date and during the preceding year, new disturbances ftiat-are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for [he beginning <br />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 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 Marble, L.L.C. <br />Address: 270 S. 15th St. <br />Canon City, CO 81212 <br />Phone Number: (770) 607-3345 <br />Fax Number _ (770) 607-3346 <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 or Owner <br />2- ~.l ~oz <br />Date <br />~o ~~ ~~(1¢-hyrS <br />M?PERMITU7ASTERD000MENTSVN-AF-01 <br />~~ s i2~~'~`- ifs <br />