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<br />~F ~- RAY <br />ANNUAL FEE and REPORT REQUEST <br />F,~ <br />PERMTTTEE NAME: ACA Products, I/nc. <br />PERMIT NO.: M-1979-010 / <br />OPERATION NAME: Avery Construction Pit <br />ANNIVERSARY DATE: January 15, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br />~~~~~a~~ <br />Division og l~eCiary}apion, <br />Mining and ~ agety <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, 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 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 durinS the previous year and no new chanEes to <br />the previous year's man are necessary, then no new map is reauired. 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 suffice for a written report. <br />"- Divis'ion`records-indicate the ;following -perniittee `contact information`- `Please verify and make airy necessary -~ <br />changes: <br />Permittee Contact: Jon Hollenbeck <br />Permittee Name: ACA Products, Inc. <br />Address: 702 Gregg Drive <br />P.O. Box 1887 <br />Buena Vista, CO 81211 <br />Phone Number: (719) 395-3790 <br />Fax. Number: -(719) 395-3794 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or ttach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of rate Officer, Owner, or Designee <br />~l'7~U~ <br />Date <br />