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ANNUAL FEE au ~ j PORT REQUEST <br />PERMITTEE NAME: ~ Colorado Quarries Inc <br />PERMIT NO.: ~-1987-116 <br />OPERATION NAME: Sisldn <br />ANNIVERSARY DATE: November 2, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Custer <br />REGF~vED <br />OCT 2 5 2001 <br />Division ofa d Safety n, <br />/ Mining <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />---reclamation accomplished-te-daft-and-du.:rig-the.-preceding-year, new-disturbances-that-are-anticipated-te-eeeur--- - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary. then no new map is required. provided that the Operator shall state <br />this in the Annualthis in the Annual Report. Please note that an adequately labeled map that clearly delineate and includes the <br />above elements may suffice jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Tezak <br />Permittee Name: Colorado Quarries Inc <br />Address: 270 S 15th St <br />Canon City, CO 81212 <br />Phone Number: (719) 275-6894 <br />Fax Number: (719) 275-2131 <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 />of <br />7 <br />Date <br />Hauling out of pit is the only activity at site this year. <br />