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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE VEST <br />ACA Products, Inc. <br />/M-1998-104 <br />J Pine Ridge Pit <br />-4 <br />t/ APR a j 2010 <br />Ply OOR of Reclamation, <br />1/ Offlne & Safety <br />April 27, 2010 <br />$791.00 (Due on or before your anniversary date) <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 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 fbr 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 may 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-ver-ify-and make-any-necessary - -- <br />changes: <br />Permittee Contact: Jon Hollenbeck <br />Permittee Name: ACA Products, Inc. <br />Address: 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 />Signature of orporate Officer, Owner, or Designee <br />3l 12.??0) a <br />Date