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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hard Rock Paving &Redi-Mix, Inc. <br />M-1977-196 <br />Buena Vista Pit <br />Apri121, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Chaffee <br />APR ~ 8 1003 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />- -- shaft-submit-the 'annttal-fee,-a report-and map ~showm~" g the eztenf of`currant disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ^nur revised written annual tenor[ and anneal tenor[ m ~n to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: T°^ n,rarr+~ <br />Permittee Name: Hard Rock Paving &Redi-Mix, Inc. <br />Address: P.O. Box 1720 <br />Canon Ciry, CO 81215-1720 <br />Phone Number (719) 275-1280 <br />Fax Number: (719) 275-8897 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~G ~- <br />S~ store of Corporate Officer, Owner, or Designee <br />~ ~~~~~ <br />Date <br />M:V'ERMn1MASTERD000MEM$VM-AF-eI <br />