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~~CFIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Hard Rock Paving &Redi-Mix, Inc. <br />M-1977-197 <br />Main Pit <br />Apri121, 2002 <br />MAY Q 7 2[-Q2 <br /> <br />i7ivision of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Chaffee <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 />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 [he beginning <br />of active operations, and the date active operations ceased for [he year, if any. <br />Please attach vour revised written annual report and annual report man to this form. Please note that an <br />adequately labeled map that clearly delineates and inclades 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: -flrt~ani <br />Permi[tee Name: Hard Rock Paving &Redi-Mix, Inc. <br />Address: P.O. Box 1720 <br />Canon City, CO 81215-1720 <br />Phone Number: (719) 275-]280 <br />Fax Number: (719) 275-8897 <br />L~ 3b3~Dt7`l-~fd.77 <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 />gnature of Corporate Officer or Owner <br />s-~-oa <br />Date <br />M:~PERMI7 VdASTERDOCUMENTSVN-AF-OI <br />