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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Pioneer Sand Company Inc <br />1/?I-1980-037-HR <br />Ingleside Quarry <br />October 1, 2009 <br />ECEIVED <br />SEP C. C, 2009 <br />Division or ', caedamafion, <br />dining and Pte'. <br />$$791.00 (Due on or before your anniversary date) <br />Larimer <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_thaL are_anticipated. to-oecur <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 during the previous Year and no new changes to <br />the previous vear'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 suffice 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 80933-7650 <br />Phone Number: (719) 599-8100 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />oP?,?a77?,?s Lb.?/77.?LC?o Ti?•1is ?ASi yE?2 /,/? io Rc,Pe ?,e?-A stibcv,? <br />D ?? Thy[ ?/' o?? ,? /?, 7 pis7Zij@,(30,0 192B4 dA4,v rho ? ?h?,?G ?Q <br />Signa C orate Of e Owner, or Designee <br />Date