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III IIIIIIIIIIIII 'll :# fq�(a a � ��g , oo-al <br /> t • l <br /> sss �� Qp) <br /> ANNUAL FEE and REPORT REOUE6f CEIVED <br /> PERMITTEE NAME: Colorado Quarries, Inc. <br /> OCT 17 2000 <br /> PERMIT NO.: M-1987-116 7wim,-.0 of Minerals&Geology <br /> OPERATION NAME: Siskin <br /> ANNIVERSARY DATE: November 2,2000 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Custer <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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> 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 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 <br /> enclosed. <br /> G <br /> Sijnature of Co orate Officer or Owner <br /> 10 - 1(9 - D(-) <br /> Date /j t <br /> Igo 4) y"' <br /> M:\PERNIrRMASTERDOCUMENTS\NI-AF-01 <br />