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PERMITTEE NAME: Pioneer Sand Company, Ina R~C~ <br />PERMIT NO.: M-2000-046 ~V~O <br />OPERATION NAME: Phillips Ranch Property Gravel Pit #2 MAy ~ 9 ~04 <br />ANNUAL FEE DUE:TE. $281.00'(Due on or before your anniversar~,dat )'M'°ef al Sand #°0I°gy <br />COUNTY: Fremont <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 accomp is a o a e an ,, ted-to-eccuF <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 attachynnr revised written anm~al re,Qnrt and anm~al report marn to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Mike Ausbum <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: <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 along with your written report and map. Annual Report instructions are enclosed. <br />Signa ure of rporate Officer, Owner, or Designee <br />s/~~~ <br />