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ANNUAL FEE and REPORT REpUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />P C Management, Inc. <br />M-1997-098 <br />Flag Creek Mine <br />March 30, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Rio Blanco <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 aze anticipated to occur <br />during [he upcoming year, reclamation that will be performed during the corning yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach your revised written annual report and annual report map 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 pemuttee contact information. Please verify and make:any necessary <br />changes: <br />Permittee Contact: Tim Robertson <br />Permittee Name: P C Management, Inc. <br />Address: 8997 County Rd. 13 <br />Meeker, CO 81641-1322 <br />Phone Number: (970) 878-4657 <br />Fax Number: (970) 878-3539 <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 instmctions aze enclosed. <br />Signature of Corporate Officer or Owner <br />Date <br />M:NERMI71MASrERD000MENTSVd-AF-OI <br />