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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />/n <br />ANN UAL FEE and REPORT REQUEST <br />llorado Quarries Inc <br />?M-1977-144 <br />Mica Lode <br />November 30, 2010 <br />P01- <br />40EC 0 6 2010 <br />Divwn of Roc*"e6en, <br />Wnirtg and Sabsiy <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <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_peceding years 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 your revised written annual report and annual report man 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 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: <br />Fax Number <br />(719) 275-6894 <br />(714) 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 qthis long with your written report and map. Annual Report instructions are enclosed. <br />S. na 4ureovloorporate wner, or Designee <br />e <br />aD X/E?o CkA(\)?Cs <br />Date