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~ECEIVEp <br />ANNUAL FEE and REPORT REQUEST ~~>aY ~ ~ TOOT <br />PERMITTEE NAME: Hard Rock Paving &Redi-Mix, Inc. Dii<isian of Minerals and Geology <br />PERMIT NO.: M-1977-196 <br />OPERATION NAME: Buena Vista Pit <br />ANNIVERSARY DATE: Apri121, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br />According to C.R.S. 34-32.5-1 l6 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 accomplished-to dace 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 your revised written annual report and annual report maa 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: ,4ngpl Rrll ~toni <br />Permittee Name: Hard Rock Paving &Redi-Mix, Inc. <br />url 1~3C~rl ~,~'jank5~ (/.cssc;ll.C~ <br />-~'--~ 303 f ~1~1' ya?7 <br />Address: P.O. Box 1720 <br />Canon City, CO 8]215-1720 <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 [o the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed, <br />,~ ~ ~~ <br />~gnature of Corporate Officer or Owner <br />S 3 -d~ <br />Date <br />M:~PERM I7IMASTERD000MENTSVv1-AF-01 <br />