2004-04-21_REPORT - M1977195

• Permit No: M1977195
• IBM Index Class Name: Report
• Doc Date: 4/21/2004
• Doc Name: Annual Fee/Report/Map
• From: Hard Rock Paving and Redi-Mix Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Hard Rock Paving &Redi-Mix, Inc.
M-1977-195
Hard Rock 291 Pit
Apri121, 2004
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APR 2 1 2004
DlVision of Minerals and Ceolagy
$281.00 (Due on or before your anniversary date)
Chaffee
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 the preceding year, new disturbances that are anticipated to occur
during the upcoming yeaz, 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 ynnr revised written anneal report and annual rennrt 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: Denise Gonzales
Permittee Name: Hard Rock Paving &Redi-Mix, Inc.
Address: P.O. Box 1720
Canon City, CO 81215-1720
Phone Number: [phone]
Fax Number: [phone]
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.
ature of Corporate Officer, Owner, or Designee
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Date