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N tE and PORT REQUEST <br />AN UAL <br />PERMITTEE NAME: Pcolorado Quarries Inc <br />PERMIT NO.: /M-1977-168 <br />OPERATION NAME: Marrs Memorials <br />ANNIVERSARY DATE: November 30, 2009 Y <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />----COUNTY:--- - Fremont - - __:--- -- - - --- - - - <br />According.to C.R.S. 34-32.5-11.6 or C.R.S_34-32-_116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <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 vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous Year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following perinittee 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 <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 f9irm along with your written report and map. Annual Report instructions are enclosed. <br />Sratu r of Corporate Officer, Owner, or Designee <br />- V r? j <br />Date