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~~~~I ~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />i ACA Products, Inc. <br />,,M-1979-010 <br />Avery Construction Pit <br />January 15, 2007 <br />~DF~ V~D <br />SAN 0 82007 <br />Dlvfslon of Reclamation <br />~ Mm(n8 and Safety <br />$$688.00 (Due on or before your anniversary date) <br />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 yeaz,-riew disturbances thafaze an"ticipated to occur- - - <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach vour revised written annual report and anuual 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 duripa the previous vear and no new chances to <br />the previous year's map are necessary, then no new map is reuuired, 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 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: Jon Hollenbeck <br />Pennittee Name: <br />Address: <br />ACA Products, Inc. <br />P.O. Box 1887 <br />Buena Vista, CO 81211 <br />Phone Number: (719) 395-3790 <br />Fax Number: (719) 395-3794 _ _ <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />~~ <br />Signature of Corporate Officer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions aze enclosed. <br />I2.l13Iq(~ <br />Date <br />