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<br />~F -~ RPM <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Hard Rock Paving &Redi Mix, Inc. <br />~~~ <br />PERMIT NO.: M-1977-197 _~ <br /> <br />APR ~ ~ 200 ~ <br />OPERATION NAME: Main Pit <br />ANNIVERSARY DATE: April 21, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: 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}perft~rmed-during-the comingyear,-tlre`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 man to this form The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />mau. If no new disturbances or reclamation have occurred durin the previous year and no new changes to <br />the previous year's map are necessary, then no new map is reauired 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 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: Denise Gonzales <br />Permittee Name: Hard Rock Paving &Redi Mix, Inc. <br />Address: P.O. Box 37 <br />Salida, CO 81201 <br />Phone Number: (719) 275-1280 <br />Fax Number: (719) 275-8898 <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 />i <br />Si re of Corporate Officer, Owner, or Designee <br />3- ~- o ~ <br />Date <br />