2007-04-20_REPORT - M1977195

• Permit No: M1977195
• IBM Index Class Name: Report
• Doc Date: 4/20/2007
• Doc Name: Annual Fee/Report/Map
• From: Hard Rock Paving & Redi-Mix, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
vlIard Rock Paving &Redi-Mix, Inc.
~M-1977-195
Hard Rock 291 Pit
Apri121, 2007
$$281.00 (Due on or before your anniversary date)
Chaffee
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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
_ _. - _shall_ submit the annual- fee, areport-and-map--showing-the-extent-of-current- disturbances to- affected land, -
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, resort, and associated
map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to
the previous year's mao are necessary, then no new mao is required, arovided that the Operator shall state
this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the
above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Denise Gonzales
Permittee Name: Hard Rock Paving &Redi-Mix, Inc.
Address: P.O. Box 1720
Canon City, CO 81215-1720
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
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Si re of Corporate Officer, Owner, or Designee
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Date