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<br /> <br /> EE an? ORT REQUEST <br /> <br />PERMITTEE NAME: PC rkle Construction <br />PERMIT NO.: LZ,995-023 <br />OPERATION NAME: Corkle Pit <br />ANNIVERSARY DATE: June 8, 2011 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Jackson <br />/MA'Y ? 6 2011 <br />ivision or Reclamation, <br />Kning and Safety <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 pmeeeding-year-, -new-disturbances that are- antleipated to -eecur - - <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 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 necessarv. then no new map is reauired. 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: Harry E. Corkle <br />Permittee Name: Corkle Construction <br />Address: 34612 Hwy. 14 <br />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 />Sign Lure of"Corporate Officer, Owner, or Designee <br />5-12-11 <br />Date <br />