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ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: ACA Products, Inc. ? ?V V. <br />PERMIT NO.: M-2005-051 tinv <br />OPERATION NAME: River Park Recreation Access Division -ul <br />ANNIVERSARY DATE: November 14, 2010 uni erg =d ` fty <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <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 disturtyances-that am-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 man 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 year's may 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: Jon Hollenbeck <br />Permittee Name: <br />Address <br />ACA Products, Inc. <br />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 attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Ae4l'at /je? &W °` ' T <br />Signature of Co orate Officer, Owner, or Designee <br />OW 8,10 0 <br />Date