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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Joe Kraig <br />Si gr• re, ='`Corpor <br />Date <br />ANNUAL FEE and REPORT REOLIE T c n�ation, <br />r � in g and afeti <br />✓Pioneer Sand Company Inc <br />M- 1985 -082 <br />Rock Pit Mine <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 />.n1_n, /1,?.v <br />lac 4- .e1 DEC 0; 2011 <br />December 30, 2011 'DEC - 0 7 2011 <br />$323.00 (Due on or before your anniversary date) jiv , , 4 , ;_, ,action, <br />Moffat <br />attd St1Liy <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 />��xeclamation_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 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 />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 />ficer, Owner, or Designee <br />