2006-07-17_REPORT - M1984043

• Permit No: M1984043
• IBM Index Class Name: Report
• Doc Date: 7/17/2006
• Doc Name: Annual Fee/Report/Map
• From: DMG
• To: Pelino Inc.
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

'fiS C.
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNfiAi. FF.F, and RF.Pt7RT RF.niTFST
Pelino, Inc.
~M-1984-043
Jesse Lee
July 25, 2006
i~ECE1VED
~~t/JUL ' 7 2006
//piuision at Minerals and Geology
$225.00 (Due on or before your auniversary date)
Chaffee.
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 shall submit the annual fee, a report and map showing the extent of current distwbances to affected
_ __ land, reclamation accomplished.to date. and during 2he_preceding.year,-new disturbances-that-are~anticipated4o
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date.active operafions ceased for the year, if any.
Please attach your revised written annual re~nrt and annnal rennrt main to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Scott Pelino
Permittee Name: Pelino, Inc.
Address: .33551 CR. 361
P.O. Box 5049
Buena Vista, CO 81211
Phone Number: [phone] .,~
Fax Number:, , ...._ _ - 7/ y - S y S =` '~t~~,
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions aze
enclosed.
i
Signature of Corporate Officer, Owner, or Designee
Date
M:~PERMI'1~MASTERD000MEN'1'SiM-AF-02.DOC