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~~ <br />,~~. <br /> AN <br />NITAL FEE and REPORT RE QUEST <br />RECE~VE® <br /> <br />PERMITTEE NAME: <br />ERMI ~ <br />'/L~'s M. Vasquez <br />1999 <br />0 <br />/ ' <br />vNOV O 9 2~ <br />P <br />T NO.: - <br />! <br />M- <br />63 <br />'~Dirision of Minerals and Geology <br />OPERATION NAME: Red Wolf Quarry <br />ANNIVERSARY DATE: August 23, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Lorimer <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 ate andaun`ng lfi'e prec~dingyear, 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 report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Abe Vasquez <br />Luis M. Vasquez <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />P.O. Sox 122 <br />Lyons, CO 80540 <br />(303)823-6116 <br />(303)823-6888 <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 />i e of Corporate Officer or Owner <br />~~~ ,- asp <br />Date <br />