2001-11-19_REPORT - M1977319

• Permit No: M1977319
• IBM Index Class Name: Report
• Doc Date: 11/19/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~~
ANNUAL FEE and REPORT REQUEST
Persolite Products, Inc.
M-1977-319
Swallow Perlite Mine
November 22, 2001
RECEIVED
NOV 19 2001
Division of Minerals and GeolopY
$225.00 (Due on or before your anniversary date)
Custer
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 year, new disturbances that are anticipated to
occur during the upcoming year, reclamation [hat will be performed during the conung year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual resort and annual report map to this form. Please mote tltnt an
adegeately Inbeled map that clearly delineates and includes the above elements may suffice jor a written
report.
Division records indicate the following permi[[ee contact information. Please verify and make any necessary
changes:
Permittee Contact: Michael J. Steiner
Permittee Name: Persolite Products, Inc.
Address; P.O. Box 505
201 S. Robinson
Florence, CO 81226
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information [ha[ should be provided [o the Division, please provide i[
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corp to Officer or Owner
/-
Date
M?PERA7ITVNASTER DDCUM ENTS/At-AF-O? DOC