2005-09-14_REPORT - M2001035

• Permit No: M2001035
• IBM Index Class Name: Report
• Doc Date: 9/14/2005
• Doc Name: Annual Fee/Report/Map
• From: ACA Products Inc
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
-- ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ACA Products, Inc.
11~I-2001-035
Trout Creek Pit
September 19, 2005
~SEP 1 ~ 2005
Diaisisa ct @7i:.tr:a L Eaaiopy
$688.00 (Due on or before your anniversary date)
Chaffee

According-to.~C_R.S.34_32.5=LL6_ocC.R.S._34_32=ll.6,_each_year,_on the_anniyeraar~date_of the_perm~t 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
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anneal rennrf and anm~al rennrt my~ fn this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Jon Hollenbeck
Permittee Name: ACA Products, Inc.
Address: P.O. Box 1887
Buena Vista, CO 81211
- -Phorie Numbet: " (9i7)-395=3790--
Fax Number: [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.
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Signature o orporate Officer, Owner, or Designee
gllg~05
Date