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o`" I t <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Pioneer Sand Company, Inc. <br />~M-1983-139 <br />Leyden Pit <br />Apri123, 2007 <br /> <br />- I ~ z ZQO~ <br />Diwa!o-, o~ ......~-~~iinn, <br />Poiin!.ig end Sa;~iy <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 />reclamation accomplished to date and during the preceding year, ne_w 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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durin¢ the previous year and no new changes to <br />the previous year's map are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: 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 that should be <br />below or attach it to this form along with your written report and map. <br />SCFs /lEU/s4'O ~/~/° Q9/ Ae.<ES H/.vEO J- GRAD~•O <br />2~s/06y <br />Signa r of Co~ rate Officer w~r, or Designee <br />.~~ ~,~ <br />Date <br />provided to the Division, please provide <br />Annual Report instructions are enclosed. <br />Ocr2%,/G a oo ~ <br />