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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Tezak Stone &Aggr Supply, Inc. <br />M-1981-080 <br />Tezak No 2 Pit <br />May 27, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />RECEIVED <br />APR 141003 <br />Division ~f Minerals and Geobgy <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 />-shalYsubmiY the-aimmuat-fee-a-report-and-map-showing the extent rof current-disturbancesrta-affected-4and; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated 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 your revised written annual report and anneal rennrt m ~n 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 />Petmittee Contact: Mike A. Tezak /7yl / S eOiLf ~ C <br />Permittee Name: Tezak Stone &Aggr Supply, Inc. <br />Address: 6200 CR 37 <br />Texas Creek, CO 81223 <br />Phone Number: (719) 275-1146 <br />Fax Number: (719) 275-1146 <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 />,K ~ /L. <br />Signa re of Corporate Officer, ner, or Designee <br />_ /Z -o <br />Date <br />M:NERMITUTASTERD000MENTSVvi-AF-0I <br />