REP21738

• Permit No: M1987026
• IBM Index Class Name: Report
• Doc Date: 11/20/2003
• Doc Name: 2003 Annual Report and Fee
• From: Colorado Quarries Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

12/302003
09:14
COLORADO QURRRIES 3 13038328106 N0.903 D03

PERM11`i'EE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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'Colorado Qnarrics, inc.
/M-1987-026
Black Obsidian
November 6, 2003
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ni.~ision of Minerals and Ceo1g9V
5281.00 (Uue on or before your anniversary date)
Custer
According to C.RS. 34-32.5-116 or C.R.S. 34-32-1 lfi, each year, on the anniversary date of the permit, an operator
shall submit the annual fee, a report and mag showing the extent of current disturbances to affected land,
reclamation accomplished to date and duriag 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.
Pleaca nttarh lnnr revicnd u•ritt .n nn rn~ rn nrt and BIIRpat re ort m p,thic F,grm_ P(egse Wore that Qtt
adequately labefed map that clearty delineates and includes the above elements may since jot a written report.
Division records indicate the following petmittee contact information. Please verify and make any necessary
changes: ,
Perrnittee Contact: 8;11 Tezak
Permittee Name: Colorado Quarries, inc.
Address: 270 S. 15th St.
Canon Ciry, CO 81212
Phone Number: [phone]
Fax Number: [phone]
Tf you hsve additional comments and/or information that should be provided ro the Division, please provide
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed-
~~
Signature o orporate Officer, Owner, or Designee
Date
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