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/V ~ <br />~~~ <br />DEC 2 C ~~;,;~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hardrock Sand and Gravel <br />M-1977-443 <br />Moon Pit No 2 <br />November 8, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Moffat <br />7inisia;, of C,6~a.s C: i°oolnpq <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-eceemp?ished-to-date-arcd-during-the-pr~cec'hr~g'yea`r; new disfutbauces that"are antTcipated`to occurA ' <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 ym~r revised written annual r~nrt and anneal report maT to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any ttecessary <br />changes: <br />Permittee Contact: Pat J. Weber <br />Permittee Name: Hardrock Sand and Gravel <br />Address: P.O. Box 141 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970)824-4053 <br />(970) 824-4053 <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 />,~/~ Q4i/yt°R <br />Si ature o Corporate Officer, Owner, or Designee <br />/1/6 Nety ~/Sru~6sfirC,eS <br />01C' /L//~v/r~~,. ~~i/S ye/1/1 <br />/~?~,~ G~ <br />Date <br />