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0/<- <br />L, <br />AL FEE and REPORT REQUEST <br />PERMITTEE NAME: Hoard Rock Paving and Redi-Mix, Inc <br />PERMIT NO.: Vfi1I-2008-018 ,j 2010 <br />OPERATION NAME: Flying Triangle Ranch Pit Divis?i ui Reclamavo i:, <br />ANNIVERSARY DATE: June 17, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land,-reclamation accomplished- to date and during the- preceding-year, new disturbances-that-are-anticipated-to- - - - <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new channes to the previous vear's map are necessarv. then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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 and Redi-Mix, Inc <br />Address: 839 MacKenzie <br />PO Box 1720 <br />Canon City, CO 81215 <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 alon ith your written report and map. Annual Report instructions are <br />enclosed. <br />Si re of Corporate Officer, Owner, or Designee JUN 2 3 L013 <br />Date <br />4lvision of Reclamation, <br />Mining & Safety <br />M:IPERMIT\MASTERDOCUNMNTS/M-AF-02. DOC