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-10 <br />0 <br />A?7_ <br />ANNU L FEE aA REPORT REQUEST <br />PERMITTEE NAME: "ard Rock Paving & Redi Mix, Inc. <br />PERMIT NO.: >M-1984-101 «j 1 ` 2010 <br />OPERATION NAME: Chaparral Meadows Pit Dlvisiu; _. ,.._._";WW <br />? Mining and Safety <br />ANNIVERSARY DATE: August 13, 2010 / v <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Park <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 beginnirig- <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear'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 Paul Ary <br />Permittee Name: Hard Rock Paving & Redi Mix, Inc. <br />Address: P.O. Box 1720 <br />Canon City, CO 81215-1720 <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 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 />Si ature of Corporate ricer, Owner, or Designee