2002-01-10_REPORT - M1977245

• Permit No: M1977245
• IBM Index Class Name: Report
• Doc Date: 1/10/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMff NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Jefferson County
M-1977-245
Pine Junction Pit
January 31, 2002
RECEIVED
JAN 10 2002
piuision of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Jefferson
According to C.R.S. 34-32.5-]16 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 cutren_t disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during [he upcoming year, reclamation that will be performed during the coming year, [he dates for [he
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report maa to this form. Please note that an
adequately labeled map that clearly delineates and includes the nbove elements may since for a written
report.
Division records indicate [he following petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Paul G. Rice
Permittee Name: Jefferson County
Address: 21401 Golden Gate Canyon Rd.
Golden, CO 80403-8108
Phone Number: [phone] __,_._-____.___
Fax Number: [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.
Signature c Corporate Officer or Owner
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Date
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