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r <br /> <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />PK Enterprises, Inc. <br />M-2000-077 <br />Mule Creek Pit <br />October 12, 2002 <br />RECEIVED <br />ocr ~ 52002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Teller <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I ]6, 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 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 Wore 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: Gregory A. Loop <br />Permittee Name: PK Enterprises, Inc. <br />Address: 111 IS W. Hwy. 24, Unit 2A <br />Divide, CO 80814 <br />Phone Number: <br />Fax Number: <br />(719) 687-6011 <br />(719)687-6788 <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 />~ (~~~~ <br />4 <br />Sign~`gf CogSorat O er~viner, or Designee <br />Date <br />M:NERMIT\MASTERD000MENTSUI-AF-0I <br />