REP09858

• Permit No: M1992045
• IBM Index Class Name: Report
• Doc Date: 7/14/2003
• Doc Name: Annual Fee/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
James VanElla
M-1992-045
Gold Basin Mine
July 21,2003
$225.00 (Due on or before your anniversary date)
Chaffee
RECEIVED
JUL 1 4 2003
Division ~f Minerals and Geology
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 m_ap 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 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 attac~ynnr revised written annual report and annual rennrt m ~n 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: James VanElla
Pemuttee Name: James VanElla ~
Address: P.O. Box 2221 C ~ I/
Granite, CO 81228 // D
Phone Number: [phone] ~~
Fax Number: 4" IIUJJ
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.
ig tore of Corporate Officer, Owner, o esignee
Date
Mrl-ERMITJdASiERDOCUMENTS/M-AF-02.DOC