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• iii iiiiiiiiiiiu iii <br />999 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNUAL: EE: sZEPOR`_I.?OUEST C) <br />Tezak Heavy Equipment Co., Inc. <br />M-1977.193 <br />T.H.E. Aggregate Source <br />November 22, 2000 <br />FtEC~`J~ A <br />~C~ 1 ~ ~ da°0\~~V <br />aetD"`~ <br />o~~ <br />Ot~tsta~ <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming yeat, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report maa to this form. /'lease note that an <br />adequately labeled map that clearly delineates and includes the above elements may su)fce for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Daniel Tezak, Jr. D0.vt i t/ ( ~~. ZA. k. <br />Permittee Name: Tezak Heavy Equipment Co., Inc. <br />Address: 201 Tunnel Dr. <br />Canon City, CO 81212-3660 <br />Phone Number: (719) 269-t 173 <br />Fax Number: (719) 269-1 ]48 <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 instmctions are <br />enclosed. <br />Signature of Corporate Officer or Owner <br />io->'a- 0O <br />Dale <br />h1 WERh1mMASTERD000MEM'SN7-AF-01 <br />