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DECEIVED <br />ANNUAL FEE and REPORT REQUEST ~'''~ ~ ~ Nm2 <br />Oivisian of Minerals and Geology <br />PERMTTTEE NAME: Corkle Construction <br />PERMIT NO.: M-1995-023 <br />OPERATION NAME: Peterson Pit <br />ANNIVERSARY DATE: June 8, 2002 <br />ANNUAL FEE DUE: $281.00 {Due on or before your anniversary date) <br />COUNTY: Jackson <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 yeaz, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report man to 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 following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Harry E. Corkle <br />Permittee Name: Corkle Construction <br />Address: Box 306 <br />Walden, CO 80480 <br />Phone Number: (970) 723-4676 <br />Fax Number: (970)'123-3208 <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 />Signature f Corporate Officer or Owner <br />g-oa <br />Dare <br />M:~PERMITMASTERDOCUMEMSN~YAF-01 <br />