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<br /> <br />RECEOVE® <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, 2004 <br />APR 1 2 2004 <br />Division of Minerals & 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 />rec amatron accomp is ea to a e and-da-iirTg'tlte cu' ~. , ., ur <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 anneal repDrt and anneal re~nrt m~ 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 petmittee 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 />(3;~~ R. Ada~son/ <br />a~9 TndN,e~rtal Park Road. NE <br />r.krsv~llc Gta 3011 <br />Satvu. <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />`below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />.r~'~-- 1 V D cha N yps ~ repor~- <br />Stgnature of Corporate Officer, Owner, or Designee <br />4 -9-Q~ <br />Date <br />