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~ ~ ~ RECEIVE~~ <br />NOY 13 2003 <br />"ANNiIAi, FF.F, and RF.PnRT RF,niJFST pivisionofMineralsandCeala;y <br />REC'~--- -E® <br />PERMITTEE NAME: Colorado Quarries, Inc. <br />PERMIT NO.: M-1987-026 .~ R W ~~ ' 3 L=~3 <br />OPERATION NAME: Black Obsidian ` <br />titiision of Ulinerais and GeobBy <br />ANNIVERSARY DATE: November 6, 2003 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Custer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />Stt~~ 11 ~it$iril[-'ih~'-annua't-fee-a r'eport'and-map-showing the-extent-of-current disturbanccs to affected :and, - <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 ymrr revised written annnal report and annnal rennrt mad }n 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: (719) 275-2131 _ T <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 [his form along with your written report and map. Annual Report instructions are enclosed. <br />~~-~ <br />~`ignature o orporate Officer, Owner, or Designee <br />~o - l~ p .~ <br />1 Date r <br />Il ~ /!lo N~ Ci~i.rn y 6-s - !9/0~~ /~o-~~r~ ~ ~7~~ ~ <br />~.~kMITU1ASTERD000MENTSVN-AF-01 <br />