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<br />ANNUAL FEE and REPORT REQUEST <br />FEB 0 71002 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Jack Pine Mining Company <br />M-1990-147 <br />Mendota Properties <br />February 12,2002 <br />RECEIVED <br />Division of Minerals and Ceofogy <br />$225.00 (Due on or before your anniversary date) <br />Clear Creek <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 <br />operator shall submit the annual fee, a report and map showing [he extent of current disturbances to affected <br />-- land,~teclama[ion accomplished to date'and during [he 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 vour revised written annual report and annual report mau to this form. Please note that an <br />adequately labeled map, that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Fabyan Watrous <br />Permittee-Name: Jack Pine Mining Company <br />Address: P.O. Box 66 <br />Idaho Springs, CO 80452-0066 <br />Phone Numbec (303) 567-2350 <br />Fax Number: <br />If you have additional comments and/or information [hat 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 <br />enclosed. <br />~,<. ~, <br />SS gnatur of Corporate Officer or Owner <br />Date <br />4~,~~' ~ <br />~~ <br />h~ <br />/~"'"~ ~~,~ J <br />M 1PERMITUTASTERD000MENTSMI-AF-02.DOC <br />