2007-04-30_REPORT - M1998104

• Permit No: M1998104
• IBM Index Class Name: Report
• Doc Date: 4/30/2007
• Doc Name: Annual Fee/Report/Map
• From: ACA Products
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMTI"fEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ACA Products
,/M-1998-104
Pine Ridge Pit
Apri127, 2007

PR ~ 0 2001
' isionofr~eaamation,
(Wining and Safety
$$688.00 (Due on or before your anniversary date)
Lake
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 annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
duririg the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual resort and annual resort map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to
the previous vear's mau are necessarv, then no new maa is required, arovided that the Oaerator shall state
this in the Annual Report. Please note that an adequately labeled map that cleardy delineates and includes the
above elements may since for a written report.
Division records indicate tfie foil"owing permifte`e contact information. Please verify and make any necessary
changes:
Permittee Contact: Jon Hollenbeck
Permittee Name:
Address:
Phone Number:
Fax Number:
ACA Products
P.O. Box 1887
Buena Vista, CO 81211
[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.
Signature of rate Officer, Owner, or Designee
3121 l a
Date