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<br /> <br />rte'" <br /> <br />~..J <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Lime Company <br />M-2000-098 <br />Monarch Quarry <br />January 15, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Chaffee <br />Diaision of f Sf,fsr:,la 5 Goolopq <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_repor~_and map showing_-t}u;~xtent_of~urrent_disturbances_to_affected~land, <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 ynnr revised written annnal report and anm~al report ma=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 />Permittee Contact: Tollie Smith <br />Permittee Name: Colorado Lime Company <br />Address: P.O. Box 1044 <br />Salida, CO 81201 <br />Phone Number: (719) 539-3525 <br />-~------Fax-Number: - - (719) 539-7292 - _ -- - - °' - -- - --- ~- -' - <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 />'~ ri~ <br />Signature of Corporate fficer, Owner, or Designee <br />I~s~~ ~~~ <br />Date <br />