2006-05-25_REPORT - M1981080

• Permit No: M1981080
• IBM Index Class Name: Report
• Doc Date: 5/25/2006
• Doc Name: Annual Fee/Report/Map
• From: Tezak Stone & Aggr Supply Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNTiAT. FF.F, and RF.Pt7RT RF.niIF.ST
lij Tezak Stone &Aggr Supply, Inc.
~-1981-080
Tezak No 2 Pit
May 27, 2006
RECEI!!ED
~~t~MAY 2 5 2006
Division of Minerals and GealOGy
$281.00 (Due on or before your anniversary date)
Fremont
tvr-s7e_.
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 annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation-accomplished-to-date and-during-tl:e-preceding-y~car,-new-disturbances that are-aniicipated-ta-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 re~nrt and anm~al reQnrt main 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: Mike A. Tezak
Permittee Name: Tezak Stone &Aggr Supply, Inc.
Address: 6200 CR 37
Texas Creek, CO 81223
Phone Number: [phone]
Fax Number: [phone]
All I S Co..~.f~ c.1'
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.
111 ,~i b~~n~tti
Signature of Corpor e Officer, Owner, or Designee
Date