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/(n ~.,.. P C ji-Y- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A-N~NUAL FEE and REPORT REQUEST <br />Hector Rodriquez <br />~M-1999-062 <br />Indio Red Quarry Number 1 & 2 <br />August 23, 2005 <br />C.~J~'vJ <br />RECEIVEp <br />~OV D 91005 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Lorimer <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 <br />operatoc-shatL_submit_the_annual_fee,_a_reporLand_map_shawing_the_extent_of currenLdisturhancesso_af£ected_ _ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual resort maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Abe Vasquez <br />Hector Rodriquez <br />P.O. Box 122 <br />Lyons, CO 80540 <br />(303)823-6116 <br />(303)823-6888 <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 />Si lure f Corporate Officer or Owner <br />~_I g -OS'~ <br />Date <br />