2000-10-17_REPORT - M1987026

• Permit No: M1987026
• IBM Index Class Name: Report
• Doc Date: 10/17/2000
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

i III IIIIIIIIIIIIIIII � � =
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME: Colorado Quarries, Inc.
RECEIVE®
PERMIT NO.: M-1987-026
OPERATION NAME: Black Obsidian OCT 17 =
ANNIVERSARY DATE: November 6, 2000 OihsionofMi118-A&GNty
ANNUAL FEE DUE: $281.00(Due on or before your anniversary date)
COUNTY: Custer
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
a 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 your revised written annual report and annual report map to this form. Please note that an
adequately labeled Wrap 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.
Signature of Co orate Officer or Owner
/0 — Ile " tg0
Date
M'.VERNIMMASTERDOCUMEMSW AF-01