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W <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />??l /r <br />ANNUAL FEE and REPORT REQUEST <br />Colorado Quarries Inc <br />/M-1982-200 <br />Red Jasper Granite <br />November 19, 2010 <br />Ila <br />PDEC C C 2010 <br />pr/iiiaA Of K*c en, <br />!Aping and 59" <br />$$323.00 (Due on or before your anniversary date) <br />Teller <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 />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 t e 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 your 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 />man. 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 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 <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 "g with your written report and map. Annual Report instructions are enclosed. <br />Sign re f Co orate Officer, ner, or Design NO I ?( IN ?l <br />Date