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YO <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />PORT 1 an RE UEST <br />REANN AL FE <br />'Colorado Quarries Inc <br />V/M-1992-058 <br />Mica White <br />August 5, 2010 <br />Mfnfn? ? ??s <br />$$323.00 (Due on or before your anniversary date) <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. 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 during the previous year and no new changes 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 Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />--Division-records-indicate-the-following-permittee-contact information. -P- Please-verify-and-make-any-necessary <br />changes: <br />Permittee Contact: Bill Tezak <br />Permittee Name: Colorado Quarries Inc <br />Address: 270S. 15`h 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 t ' form along with your written report and map. Annual Report instructions are enclosed. <br />Signe of Corporat Of icer, Owner, or Designee t C / ??, n <br />Date