2016-11-16_REPORT - M1979010

• Permit No: M1979010
• IBM Index Class Name: Report
• Doc Date: 11/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: ACA Products, Inc.
• Annual Report Year: 2017
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:

Permittee Contact:

Michael D. Coleman
Permittee Company:

ACA Products, Inc.
Address:

P.O. Box 1887
Buena Vista, CO 81211

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Chuck Murphy
Company:

ACA Products, Inc.
Address:

702 Gregg Drive
P.O. Box 1887
Buena Vista, CO 81211

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Chuck Murphy
Company:

ACA Products, Inc.
Address:

702 Gregg Drive
P.O. Box 1887
Buena Vista, CO 81211

Phone Number:

[phone]
Fax Number:
Email Address:

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01