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R~GIt=~~/~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ACA Products, Inc. <br />M-1979-010 <br />Avery Construction Pit <br />_ - January 15, 2004 _ __ - - . __ <br />JAN 1 4 2004 <br />~~ <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />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 ynnr revised written anneal report and anneal report man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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 />Permittee Name: ACA Products, Inc. <br />Address: 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 />l <br />Signature of Irate Officer, Owner, or Designee <br />Date T <br />M:\PERMITUTASTER DOCUM ENTS\M-AF-01 <br />