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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 />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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 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 records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joe Kraig <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Signat ��f Co -. orate 0 <br />Date <br />Pioneer Sand Company, Inc. <br />P.O. Box 7650 <br />Colorado Springs, CO 80933 <br />(719) 599 -8100 <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 />7 ye P,9# 7: -a ,r*.M F,e aol/ / .97$94/74a <br />A AL FEE and REPORT REQUEST <br />Dy ioneer Sand Company, Inc. <br />t 44- 2003 -016 <br />Heit Sand and Gravel Mine <br />P FP 13 7n9 <br />$$791.00 (Due on or before your anniversary date) ' Mining of and gad d Salat 'ety <br />September 27, 2011 <br />Weld <br />Owner, or Designee <br />,e/o r <br />1 <br />RECE <br />!V O <br />