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C! /vll~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ ANNUAL FEE and REPORT REQUEST <br />~ Colorado Quarries, Inc. <br />/M-1982-200 <br />Red Jasper Granite <br />November 19, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Teller <br />6Nl~OlZ <br />io~~~ <br />RECEIVED <br />/ pCT 2 0 2065 <br />~iviaion of Reclamation, <br />Mining and Safety <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 />___ reclamation accomplished to date and during the Rr.€cedi~ear~new disturbances.that_arc_anficipated.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 annual renort 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 />ma If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous year's man are necessary. then no new man is required. nrovided that the Operator shall state <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements neay sufftce 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 Ciry, 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 to the Division, please provide it <br />bel~ow~o~ryattach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~~J.~Y" <br />~gnature of orporate Officer, Owner, or Designee <br />Date ~ 1~ d~ ~'si I.S Sf`~ ~~/ 5 ~~c°~ <br />,r/ ~~ t v~ y <br />