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<br />ANNUAL FEE AND REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ACA Products, Inc. <br />M-1979-010 <br />Avery Construction Pit <br />January 15, 2003 <br />fiECEIVED <br />FEB 1 3 233 <br />Givision of Minerals and Goology <br />$ 688.00 (Due on or before anniversary date) <br />Chaffee <br />According to CRS 34-32,5-116 or CRS 34-32-116, each year, on the anniversary date of the <br />permit, an operator shaft submit the annual fee, a report and map showing the extent of current <br />disturbances to affected land, reGamation accomplished to date and during the preceding year, <br />new disturbances that are anticipated to occur during the upcoming year, reGamation that will be <br />pertormed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased forthe year, if any. <br />Please attach your revised written annual report and annual report map to this foam. Please note <br />that an adequately labeled map that clearly delineates and inGudes the above elements may <br />suffice for a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any <br />,necessary.changes__- _ ...- _ - --° ,. __ ~. - -.-- --- .~ <br />Permittee Contact: Chuck Murphy <br />Permittee Name: ACA Products, Inc. <br />Address: PO Box 1887 <br />Buena Vista, CO 81211 <br />Phone Number: (719) 395 - 3790 <br />Fax Number (719) 395 - 3794 <br />Jon Hollenbeck <br />if you have additional comments and/or informatron that should be provided to the Division, <br />please provide R b w or a ch it to this form alon with your written report and map. Annual <br />Report in~tructi s a d enclose _ / <br />Signature of <br />or <br />~lI Io3 <br />Date <br />