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II I IIIIIIIIIIIII III CK Wp 7330 \ tsB co <br /> DEC 112= <br /> ANNUAL FEE and REPORT REQUEST plylsion of Minerals and geology <br /> PERMITTEE NAME: Centennial Materials, Inc. <br /> PERMIT NO.: M-1976-009-HR <br /> OPERATION NAME: Menzer Quarry <br /> ANNIVERSARY DATE: December31,2000 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: El Paso <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date cf the permit, an <br /> operator shall submit the annual fee, a report and map showing die extent of current dis[wbances to affected <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 report map to this form. Please nose that an <br /> adequately labeled map that clearly delmeales and includes the above elements may szffice for a wri(ten <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Scott Davis <br /> Permittee Name: Centennial Materials, Inc. <br /> Address: 2635 Delta Dr. <br /> Colorado Springs, CO 80910 <br /> Phone Number: ('119) 392-4207 <br /> Fax Number: (719) 392-4245 <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 <br /> enclosed. <br /> Signature of Corporate Officer or Owner <br /> 11,- 13-00 <br /> Date <br /> M TERMITIMASTERDOCUMENTSW-AF-01 <br />