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~~~ <br />~vvi <br />PERMI"11TEE NAME <br />PERMI I NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />shall <br />during <br />of acti <br />,~ ANNiiAi, FF.F, and REPORT RF.OiTF.ST <br />//FIard Rock Paving &Redi-Mix, Inc. <br />M-1977-196 <br />Buena Vista Pit <br />RE~EC~/E® <br />~ APR 2 1 2Q06 <br />~Divisian of Minerals and Geab~y <br />Apri121, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Chaffee <br />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 />iit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />raccomplished-to-date-and-during-the'prebeding'year tiew disturbances that are anticipated-to-o"ccnr '^ <br />upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />aerations, and the date active operations ceased for the year, if any. <br />ich ymrr revised written anmral report and anmral report main to this form- Please note that an <br />labeled map that clearly delineates and includes the above elements may since for a written report. <br />indicate the following permittee contact information. Please verify and make any necessary <br />Contact: Denise Gonzales <br />Name: Hard Rock Paving &Redi-Mix, Inc. <br />P.O. Box 1720 <br />Canon City, CO 81215-1720 <br />Phone N I tuber: (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 />of Corporate Officer, Owner, or Designee <br />~-a <br />Date <br />