REP07926

• Permit No: M1983011
• IBM Index Class Name: Report
• Doc Date: 3/31/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Jelen & Son, Inc.
M-1983-011
Willow Creek Mine
February 23, 2003
MAR 3 t 2003
Division ~f Minerals and Geology
$225.00 (Due on or before your anniversary date)
Lake
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-repaR-and-map-showing-the-extenYof 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 that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ymrr revised written anneal rennrt and anneal rennrt m~ to this form. please note that an
adequately labeled map that clear/y delineates and includes the above elements may suffice for a written
report.
Division records indicate the following petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Kay Blecha
Permittee Name: Jelen & Son,Inc.
Address:
Phone Number:
Fax Number:
C/O DWS Investments, Ltd.
1153 Bergen Pkwy., M-409
Evergreen, CO 80439
[phone]
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.
/o' ~~
Signature of Corporate Officer, Owner, or Designee
- L3~-~
Date
M iPEAMI'MIASTERDOCUMENTS/M-AF-02.DOC