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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Pioneer Sand Company, Inc. <br />M-1983-139 <br />Leyden Pit <br />April 23, 2002 <br />RECEIVED <br />APR 1 1 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Jefferson <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 />recian-iatiou accomplished- to date and during- the preceding-year,-aew- disturbances that -are anticipated to occur_ <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual reuort man to this form. Please note that an <br />adequately labeled map that clearly 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: Joe Kraig <br />Permittee Name: Pioneer Sand Company, Inc. <br />Address: P.O. Box 7650 <br /> Colorado Springs, CO 80933 <br />Phone Number: (719) 599-8100 <br />_ Fax Number:-_ (719) 599-5317 _ <br />If you have additional comments and/or information [hat should be provided to the Division, please provide it <br />below or attach it [o this form along with your written report and map. Annual Report instructions are enclosed. <br />/~ I C3~'~~.c~ <br />Sign ure~ Corporate fficer or Owner <br />//~ -fJ Z <br />Date <br />M 1PERM771MASTERD000MENTSNI-AF-OI <br />