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0',- & 2PT <br />ANNUAL FEE and REPORT REOUEST? <br />PERMITTEE NAME: ?-Pioneer Sand Company Inc -/ OCT 0,8 2010 <br />PERMIT NO.: M-1977-057DiWWen f , <br />OPERATION NAME: Fedinec Pit <br />ANNIVERSARY DATE: November 22, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: 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 />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_conung 4 eu 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 />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 necessarv. 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 />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) 593-0167 <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 />?RcTideTy ?his sT y??2 VAS L? ?,??r P 7o Ro.9-0 of ,t,,r o G2q?o??G ??D tJ? ?p lo,7T, o? <br />Signatu Co e Offi , gfwner, or Designee <br />A0 12 X/21) <br />Date <br />