2001-10-24_REPORT - M1977193

• Permit No: M1977193
• IBM Index Class Name: Report
• Doc Date: 10/24/2001
• Doc Name: Annual Fee/Report Notice
• Media Type: D
• Archive: No

III ��I��II�II RECEIVED
O7242001
ANNUAL FEE and REPORT REQUEST
Division of Minerals and Geology
PERMITTEE NAME: Tezak Heavy Equipment Co., Inc.
PERMIT NO.: M-1977-193
OPERATION NAME: T.H.E. Aggregate Source
ANNIVERSARY DATE: November 22,2001
ANNUAL FEE DUE: $688.00(Due on or before your anniversary date)
COUNTY: Fremont
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator
shall submit the annual fee, a report 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 your revised written annual report and annual report 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 Hake any necessary
changes:
Permittee Contact: Daniel Tezak
Permittee Name: Tezak Heavy Equipment Co., Inc.
Address: 201 Tunnel Dr.
Canon City, CO 81212-3660
Phone Number: (719) 269-1 173
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Divisioi, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
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