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bmk <br />r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />P-0 7- <br />ANNUAL FEE and REPORr REQUEST <br />?-PK Enterprises, Inc. <br />?M-2000-077 <br />Mule Creek Pit <br />October 12, 2010 <br />RECEIVED <br />V <br />SEP 2 2 2090 <br />DWWI*n of Roi4noglt, <br />Minin-9 4 ?$Afgp/ <br />$$791.00 (Due on or before your anniversary date) <br />Teller <br />014, <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 year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will- be performed-during- the-coming-year, the dates -for_ the begmmng _ <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 map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: 11115 W. Hwy. 24, Unit 2A <br />P.O. Box 729 <br />Divide, CO 80814 <br />Phone Number: (719) 686-1566 <br />Fax Number: (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 />dAAJ - 1 51o'e - ? ?r A <br />Si e o orporate Officer, ner, or Designee <br />Date