2005-01-20_REPORT - M1979010

• Permit No: M1979010
• IBM Index Class Name: Report
• Doc Date: 1/20/2005
• Doc Name: Annual Fee/Report/Map
• From: ACA Products Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ACA Products, Inc.
M-1979-010
Avery Construction Pit
January 15, 2005
~/
JAN pp~
Orvision o/ Minerals and Geology
$688.00 (Due on or before your anniversary date)
Chaffee
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
__ __shall_submit,_the_amrual~'ee,_a_report_and mapshowing_the extent.of current .disturbancesln.affected_land„_ __
reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anneal re~nrt and anneal re_pnrt main to this fnrm_ Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Jon Hollenbeck
Permittee Name: ACA Products, Inc.
Address: P. O. Box 1887
Buena Vista, CO 81211
Phone Number:
Fax Number:
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
~I
Signature of orate Officer, Owner, or Designee
-~t, (os
Date