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ANNIiAi, FFF, and RF,PnRT RF,OiiF,ST <br />NOV 2 5 <br />PERMITTEE NAME: Colorado Quarries, Inc. <br />- Civision of Minerals and GeolagY <br />PERMIT NO.: M-1977-144 <br />OPERATION NAME: Mica Lode <br />ANNIVERSARY DATE: November 30, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />According to C.R.S. 34-32.5-I 16 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 anmral reTnrt and anneal rennrt maTtn 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: 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 (714) 275-2131 ~ - -~-~~~ -~ _ ~ -~- <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 />.~~~ <br />Signature of C orate Officer, Owner, or Designee <br />/~~le 03 <br />Date <br />/1Jo /l~r~ c~ 1~G~9~S /~' ~ jG~~ ~S! ~~' fi i5 yc~/L. <br />~/PUS~I~ y~o7e6- a/v ~~S <br />