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<br />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 <br />Division of Minerals and Geolag~~ <br />M-1977-195 <br />Hard Rock 291 Pit <br />Apri121, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Chaffee <br />APR 18 2003 <br />___ According to C.R. S,_34.32,$_11.6 or G•R,S. 34-32-LL6,~ach year, on_the.anniversary date of the.pemut,.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 ymn• revised written annnal rennrt and annnal re nP rt main 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 necessary <br />changes: <br />Permittee Contact: Txgtvfartin- <br />PermitteeName: Hard Rock Paving &Redi-Mix <br />Address: P.O. Box 1720 <br />Canon City, CO S 1215 <br />Phone Number: (719) 275-1280 <br />Fax Number: (719) 275-8897 <br />~f~.lPvtiCP ~D/l~~s <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />s ~~ <br />ature of Corporate Offtcer, Owner, or Designee <br />~~17~~ <br />Date ~ _ <br />M iPEAM ITNIASTERDOCUMENTSUI-AF-01 <br />