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r l • III IIIIIIIIIIIIIIII • <br /> 999 <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMrl7EE NAME: Colorado Quarries, Inc. <br /> PERMIT NO.: M-1992-058 RECEIVED <br /> OPERATION NAME: Mica White AUG 0 1 2001 <br /> ANNIVERSARY DATE: August 5,2001 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary[Niop <br /> of Minerals and Geology <br /> COUNTY: Fremont <br /> 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 <br /> shall._submit the-annual fee. a report and-map showing the extent of-current disturbances-to affected-land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <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 your revised written annual report and annual report map to this form. Please note that air <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: L <br /> Permittee Contact: Bill Tezak (�.� et J <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 /> f <br /> Signature of drporate Officer or Owner <br /> 7 <br /> Date <br /> Ad 6ieN9,P--5 <S �7 <br /> MAPER M rRM ASTERDOC U M ENTSW-AF-01 <br />