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ap*,-Qf> -r <br />ANNUAL FEE and REPORT RE VEST <br />PERMITTEE NAME: ACA Products, Inc. <br />PERMIT NO.: / M-1998-104 <br />OPERATION NAME: Pine Ridge Pit <br />ANNIVERSARY DATE: April 27, 2011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br /> <br /> <br />JoWhon Of Reclamatip <br />A'nilig &Safety <br />RECEI <br />`/APR 18 2011 <br />COUNTY: Lake Division of Reclamation, <br />Mining and Safety <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 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 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 />M? CANct e 1?. C n 1e vVnav\ <br />Permittee Name: ACA Products, Inc. <br />Address: 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 />Ktd nJ ?) 0 X'r?? <br />Signature of Corp rate Officer, Owner, or Designee RECEIVED <br />" l 1611. APR 182011 <br />Date <br />Division of Reclamation, <br />Mining & Safety