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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Fred L Korinek <br />PERMIT NO.: M-1979-131 <br />OPERATION NAME: Korinek S & G Pit <br />ANNIVERSARY DATE: July 27, 2008 <br />ANNUAL FEE DUE: QZ3.0u before your anniversary date) <br />Past due <br />8/1/08 <br />COUNTY: , <br />, <br />ey <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 <br />operator-shall-submit-the-annual-€ee; a-report-and-map-showing-the_e,xtent_of-current. disturbances_to-affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is-required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />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: Fred L. Korinek <br />Permittee Name: <br />Address: <br />Phone Number: (719) 254-7271 <br />Fax Number: <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 />gnature of Corporate Officer or Owner <br />Fred L Korinek <br />550 Lane 15 <br />Manzanola, CO 81058 <br />Date