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<br /> ANNUAL FEE and REPORT REOUEST <br /> <br />PERMITTEE NAME: Pelino, Inc. ? <br /> / <br />? <br />PERMIT NO.: M-1984-043 <br />OPERATION NAME: Jesse Lee <br />ANNIVERSARY DATE: July 25, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br /> <br />AUG <br />Division. -. ,,,clamation, <br />Mining and Safety J <br />----- - According-to-C-.R-S-34-3-2-5---1-1-6-or C-R S-34 32--11-6,-each-year; on-the-anniversary-date-of the-permi?an - <br />operator shall submit the annual fee, a report and map showing the extent 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 your revised written annual report and annual resort 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 may. If no new disturbances or reclamation have occurred durine the previous year and no <br />new chances to the previous vear's map are necessarv. then no new maD is reauired. 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: Scott Pelino <br />Permittee Name <br />Address: <br />Pelino, Inc. <br />P.O. Box 5049 <br />33551 CR. 361 <br />Buena Vista, CO 81211 <br />Phone Number: (719) 395-2093 <br />Fax Number: (719) L 3qs ('0 Q z. `cam <br />If you ave additional comments and/or information that should be provided to the Division, please provide it <br />Belo r attach i to this form along with your written report and map. Annual Report instructions are <br />encl d. <br />Signature of Corporate Officer, Owner, or Designee <br />2y-o8 <br />Date <br />M:\PERMIIIMASTERDOCUMENTS/M-AF-02.DOC