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ft~~~Q~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Hard Rock Paving &Redi-Mix, Inc. <br />PERMIT NO.: /M-1977-197 <br />OPERATION NAME: Main Pit <br />ANNIVERSARY DATE: Apri121, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br />k~ <br /> <br />dE~p, <br />Di , ,;,, _ z G ltiQ~ <br />~, <br />i!Srr.'rr £qt. S`f 1 ~IPI~c,7, <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; areport-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 the year, if any. <br />Please attachyouur 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, resort, and associated <br />mau. If no new disturbances or reclamation have occurred during the previous veer and no new chanties to <br />the previous year's maa are necessary, then no new maa is required, provided that the Ouerator 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 jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Denise Gonzales <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) 275-8898 <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 />c_~ss~'~G~~ <br />Si re of Corporate Officer, Owner, or Designee <br />'~~ <br />~ - ~ ~7 <br />Date <br />