REP03551

• Permit No: M1984094
• IBM Index Class Name: Report
• Doc Date: 7/5/2002
• Doc Name: 2002 Annua Report
• From: Sanborn Sand and Gravel
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Sanborn Sand and Gravel
M-1984-094
Gloria Z Mine
July 17, 2002

~~ ~ CEI~/~P~
JUL 0 52001
Jvision of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Park
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-disturbances to affected-land,
reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual resort and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: ~~r
Permittee Name: Sanborn Sand and Gravel
Address: P.O. Box 362
Fairplay, CO 80440
Phone Number: [phone]
Fax Number: [phone]
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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 are enclosed.
T~ <
Signature of orate Officer or Owner
G~i~o ~
Date
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