2005-11-07_REPORT - M1987026

• Permit No: M1987026
• IBM Index Class Name: Report
• Doc Date: 11/7/2005
• Doc Name: Annual Fee/Report/Map
• From: Colorado Quarries Inc
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
" //Colorado Quarries, Inc.
~'M-1987-026
Black Obsidian
November 6, 2005
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RECEIVEp
'~NOV 0'71005
/n Division of Minerals end Geology
$281.00 (Due on or before your anniversary date)
Custer
~a>rding_to_(` R C ~d~ ~_7 1 fi nr C R S x¢32=1]b,gach_Xeac. on the annivers~ date of the Hermit, an operator _
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written annnal r~nrt and anm~al report m ~n to Chic form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Bill Tezak
Permittee Name: Colorado Quarries, Inc.
Address: 270 S. 15th St.
Canon City, CO 81212
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
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Signature of Cor rate Officer, Owner, or Designee
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