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~~ ~- ~P~ <br />ANNUAL FEE and REPORT REQUEST <br /> RECEIVED / <br />PERMITTEE NAME: ACA Products, Inc. <br />PERMIT NO.: M-2005-051 / NOV 05 'LOUT <br />OPERATION NAME: River Park Recreation Access Division of Reclamation <br /> Mining and Safety <br />ANNIVERSARY DATE: November 14, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />/ <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 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 resort 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 />ma . If no new disturbances or reclamation have occurred durinc the previous year and no new chances 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 -recordindicate the following p`ermittee contact-informs o 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 />~r '4 <br />Signature of Co to Officer, Owner, or Designee <br />)aI~~IO~ <br />Date <br />