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~`' <br /> <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANrIIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~/ r ~P l <br />ANNUM, FEE and REPORT REQUEST <br />t/Hard Rock Paving &Redi Mix, Inc. <br />v1VI-1985-008 <br />Leone-Gardner Gravel <br />RECErvEo <br />1/fMAR 2 U 2008 <br />D~ision of ReGamation, <br />,~A~Ining and Saffety <br />March 22, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Huerfano <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 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 map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />ma If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: John P. Ary <br />Permittee Name: Hard Rock Paving &Redi Mix, Inc. <br />Address: 839 Mackenzie Ave. <br />Canon City, CO 81212 <br />Phone Number: (719) 275-1280 <br />Fax Number: <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 />ature of Corporate Officer, Owner, or Designee <br />~~l 7- O/j <br />Date <br />