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cb~ <br />_ - <br />~ ANNTIAT. FF.F, and RF,PnRT RF.t7iiF,ST REC~i'~Ll~ <br />PERMITTEE NAME: ~ ACA Products "APR Q ; L~06U <br />PERMIT NO.: ;/ M-1998-104 vDiwoion o(Mmerals and Geology <br />OPERATION NAME: Pine Ridge Pit <br />ANNIVERSARY DATE: _Apri127, 2006 _ _ _ ,~__~ __ _- - ___ _ _ _ . <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: <br />Lake <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 exte_nt_ 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 ym~r revised written annnal rennrt and annnal repyRt maTtn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Jon Hollenbeck <br />Permittee Name: ACA Products <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 />~` I <br />Signature o orporate Officer, Owner, or Designee <br />312f~I~ <br />Date <br />