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Ci <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />6 Pioneer Sand Company Inc <br />?M-1985-082 <br />Rock Pit Mine <br />December 30, 2009 <br />NOV 0 6 2009 <br />Division of Reclamation, <br />Mining and Safety <br /> <br />$323.00 (Due on or before your anniversary date) <br />Moffat <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 />- ----rec-lamation--accompkshed to date-and during-the preceding year, new-distur-banees-that -are-antieipated-te,-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 may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />Ma 2. If no new disturbances or reclamation have occurred during 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 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 <br />Phone Number: (719) 599-8100 <br />Fax Number: (719) 598-7605 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />Blow or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />M/.?/MnI lie<,Ivd HG7,-(&-11T 7fWls Pf)STy£r?R. n!c Appi?a,?l?! ?isru E/? AR??, RGTivI? <br />b R?.G?i?l? L Gc! E?,p ?p r7Tlp/; <br />n/p Q t p S ?o aK /E R 00,4/ <br />Signature oepor, fficer, Own , or Designee <br />Date