2005-08-11_REPORT - M1984101

• Permit No: M1984101
• IBM Index Class Name: Report
• Doc Date: 8/11/2005
• Doc Name: Annual Fee/Report/Map
• From: Hard Rock Paving and Redi-Mix Inc.
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNIlAT, FF.F. and RF.PTTRT RF.t1iiF.ST
Hard Rock Paving &Redi-Mix, Inc. ~~
~M-1984-101
Chaparral Meadows Pit
August 13, 2005
$688.00 (Due on or before your anniversary date)
Park
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According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an
shall submit the annual Yee, 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 year, 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 y~.r revised written anm~al re~lnrt and anneal report man to this form. Please note that an
adequately labeled map chat clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: John Paul Ary
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.
afore of Corporate Officer, Owner, or Designee
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Date