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RECEI!!E® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Pioneer Sand Company, Inc. <br />M-1977-057 <br />Fedinec Pit <br />November 22, 2003 <br />ocr a ~ aoo3 <br />lJieision of Minerals and Goolo®y <br />$281.00 (Due on or before your anniversary date) <br />Moffat <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~Lf cu_rrent_disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new 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 ~nur revised written anneal report and anneal r~o~rt m ~n fn 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 Itraig <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 />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 />,~ ~/o ~,/.,.a,i G .~4cT. ~,TY ,T R~P~T fo.2 77/z' f~57f~tr,9R, f/c T~,,~ G <br />n/ B ~/ To /.i'z ?7' <br />Signatur'of Co rate Offic nee, or Designee <br />i i <br />Date <br />M:\PERMn1MASTER DOC UMENTSU-I-AF-01 <br />