2011-01-03_REPORT - M1979010

• Permit No: M1979010
• IBM Index Class Name: REPORT
• Doc Date: 1/3/2011
• Doc Name: Annual Fee/Report/Map
• From: ACA Products, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME;
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
A RP-r
ANNUAL FEE and REPORT REQUEST
??ACA Products, Inc.
M-1979-010
Avery Construction Pit
January 15, 2011
? JAN 0 3 2011
? "ifts f*KWNWdM
minke "ll $791.00 (Due on or before your anniversary date) tow
Chaffee
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report may to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's may are necessary, then no new may is required, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may suffice for a written report.
Division recordsindicate the -following permittee contact-information. Please "verify aid make any necessary
changes:
Permittee Contact: Jon Hollenbeck
Permittee Name:
Address:
_ M ? C...(n a.e- l '6, C 0 <'e'mcf 0
ACA Products, Inc.
702 Gregg Drive
P.O. Box 1887
Buena Vista, CO 81211
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Ldmy-'1 I 1 lyY?-per PM-ThoLq-
Signature of Corporate Officer, Owner, or Designee
8.20 k-0
Date