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a~w <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Quarries, Inc. <br />M-1977-168 <br />Marrs Memorials <br />November 30, 2005 <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />vl~~ <br />RECEIVED <br />DEC 2 22005 <br />Division of Minerals and GeoloAY <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 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 annnal rennrt and annnal rennrt m ~n to this form. Please note fhat an <br />adequately labeled map that clearly delineates and includes the above elements may since 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 City, CO 81212 <br />Phone Number: (719), 275-6894 <br />Fax Number: (719) 275-2131 <br />If you have additional comments andlor 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 />Si ature of Co rate Officer, Owner, or Designee <br />i~-~- ~s~ <br />ate <br />