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~~ <br /> U ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ <br />ACA Products, Inc. <br />PERMIT NO.: ~ <br />~ <br />'~ M-2005-051 <br />OPERATION NAME: River Park Recreation Access <br />ANNNERSARY DATE: November 14, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br /> <br /> <br />f2~~~~~_9~~ <br />t/QCT 2 3 zoos <br />rvision 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 vour 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 chances to <br />the previous year's map are pecessarv, 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 since 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 <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~6~~2~-- <br />Signature of C rate Officer, Owner, or Designee <br />{OIFfo`0(~ <br />Date <br />