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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Colorado Quarries, Inc. <br />M-1977-202 <br />Lustre No 1 <br />November 30, 2002 <br />1~ECElVED <br />NOV 0 8 2002 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Jefferson <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-] 16, each year, on the anniversary date of [he permit, an operator <br />_. _. _shall_submit_the_annual_fee,_a_report_and map-showing-the--extent-of-current-disturbances-to--affected-1and,- <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, [he 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 annual resort and annual report map to this form. Please note that ait <br />adequately labeled map that clearly delineates and includes the above elements may since for a wruten report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee 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) 275-6213 <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 />c <br />-~~- t <br />Signature of Co orate Officer, Owner, or Designee <br />ICS- tU- OS <br />Date { r~ <br />~O Ct t? /9"/l ~ c5 ~~ r b /~~asC~ <br />M:~PERM ITUTASTERDOCUM ENTSVv1-AF.01 <br />