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.' <br />~~ ~ ~~ <br />ANNUAL FEE and REPORT REQUEST <br />i. ~, <br />PERMITTEE NAME: Hard Rock Paving &Redi Mix, Inc. '~ ~ ' <br />PERMIT NO.: M-1977-195 `~ ~ APR ~ - 2~I~,a, <br />~:. <br />`~ ~'=~ ~~JJ yr. <br />OPERATION NAME: Hard Rock 291 Pit ~J' '.°r,T., ~ ~ --' :°~ <br />ANNIVERSARY DATE: Apri121, 2009 <br />ANNUAL FEE DUE: $323.00 (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 />--" ~-3iiring the upcoming year, reclamatio`n~ha~itl-be performed-during-the coming year, the dates for the-boginning-- ---- -- <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 />map. 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: Denise Gonzales <br />Permittee Name: <br />Address: <br />Hard Rock Paving &Redi Mix, Inc. <br />P.O. Box 37 <br />Phone Number: <br />Fax Number: <br />Salida, CO 81201 <br />(719) 539-2222 <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 ture of Corporate Officer, Owner, or Designee <br />3-~~.-~~ <br />Date <br />