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<br />ANNUAL FEE and REPORT REOUEST <br />pb- <br />PERMITTEE NAME: Hard Rock Paving and Redi-Mix, Inc RECEIV60 <br />PERMIT NO.: ? M-2008-018 JUN 17 2011 <br />OPERATION NAME: Flying Triangle Ranch Pit Division of Reclamation, <br />Mining and Safety <br />ANNIVERSARY DATE: June 17, 2011 Mining 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, axepor_t_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 map If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous vear's map are necessary, 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 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 />Hard Rock Paving and Redi-Mix, Inc <br />Address: <br />Phone Number: <br />Fax Number: <br />839 MacKenzie <br />PO Box 1720 <br />Canon City, CO 81215 <br />(719) 275-1280 <br />(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 ong with your written report and map. Annual Report instructions are <br />enclosed. <br />Sign re of Co orate fficer, Owner, or Designee <br />Date <br />M:\PERMIT%A A TERDOCUMENTS/M-AF-02.DOC