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lRF * QPT- <br />ANNUAL FEE and REPORT REOUEST R rI PIE iV[ 4 <br />PERMITTEE NAME: Corkle Construction MAY 1- 2009 <br />PERMIT NO.: M-1995-023 L /3y Division of nect:mation, <br />(y Mining and Safety <br />OPERATION NAME: Corkle Pit <br />ANNIVERSARY DATE: June 8, 2009 <br />ANNUAL FEE DUE: $323.00 (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-aceomplished-to-date-and-during-the-preceding-year-,- new-disturbances-that-are-anticipated-to-e cur -- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report may 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 year'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 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: P.O. Box 306 <br />Walden, CO 80480 <br />Phone Number: (970) 723-4676 <br />Fax Number: (970) 723-3208 <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 />'00A11 46-L= <br />Signature orporate Officer, Owner, or Designee <br /> <br />Date