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<br />111 IIIIII1111111111 <br />999 <br />RECEIVED <br />ANNUAL FEE and REPORT REQUEST <br />OCT 1 5 2001 <br />Division of Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hector Rodriquez <br />M-]999-062 <br />Indio Red Quarry Number 1 & 2 <br />August 23, 2001 <br />$251.00 (Due on or before your anniversary date) <br />Lorimer <br />According [o C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, each year, on [he 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. Please note that art <br />adequately labeled map that clearly delineates and includes rite above elernenrs may suffice for a written report. <br />Division records indicate the following permi[tee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Hector Rodriquez <br />Hector Rodriquez <br />P.O. Box 1504 <br />Lyons, CO 80540 <br />(303)823-6452 <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 />L% ~,.~-,,,,, r <br />Signature of Corpo"resat-eOfficer or Owner <br />0 ~31- ~1 <br />Date <br />M IPERA1rIVv1A5TERIXJCUMENT5NI-AF-01 <br />