2005-10-21_REPORT - M1977193

• Permit No: M1977193
• IBM Index Class Name: Report
• Doc Date: 10/21/2005
• Doc Name: Annual Fee/Report/Map
• From: Tezak Heavy Equipment Co. Inc.
• To: DMG
• Media Type: D
• Archive: No

RF ;Rte
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
r~ Te~k Heavy Equipment Co., Inc.
vM-1977-193
T.H.E. Aggregate Source
November 22, 2005
~~~
RECEIVED
~Ct 2 1 2DD5
DfVidion of Minarets and GeoloBY
$688.00 (Due on or before your anniversary date)
Fremont
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
shall submit the annnal fee, a renort 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 ynnr revised written annnal rf,pprt and annnal renort map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Daniel Tezak
Permittee Name: Tezak Heavy Equipment Co., Inc.
Address: 205 Tunnel Dr.
Canon City, CO 81212-3660
Phone Number; [phone]
Fax Number: [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.
Signatur of Of~ e~r,~Owner, or Designee

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Date