REP06018

• Permit No: M1999062
• IBM Index Class Name: Report
• Doc Date: 10/15/2001
• Doc Name: ANNUAL FEE REPORT REQUEST
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

111 IIIIII1111111111
999
RECEIVED
ANNUAL FEE and REPORT REQUEST
OCT 1 5 2001
Division of Minerals and Geology
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Hector Rodriquez
M-]999-062
Indio Red Quarry Number 1 & 2
August 23, 2001
$251.00 (Due on or before your anniversary date)
Lorimer
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. Please note that art
adequately labeled map that clearly delineates and includes rite above elernenrs may suffice for a written report.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Petmittee Contact
Permittee Name:
Address:
Phone Number:
Fax Number:
Hector Rodriquez
Hector Rodriquez
P.O. Box 1504
Lyons, CO 80540
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
L% ~,.~-,,,,, r
Signature of Corpo"resat-eOfficer or Owner
0 ~31- ~1
Date
M IPERA1rIVv1A5TERIXJCUMENT5NI-AF-01