Laserfiche WebLink
OCT-02-2007 07:4BAM FROM-DIV RECLAfMTION MINING i SAFETY 3038328102 <br />z <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Gail C. Allen and Mil/lie J. Allen <br />PERMIT NO.: M-2D00-DSD r/ <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Broken Spear Pit <br />October 2, 2047 <br />T-566 <br />RECEIVED <br />OCT 0 3 2001 <br />Division of Reclamation, <br />Mining and Safety <br />$$323.00 (Due on or before yoar anniversary date) <br />Lincoln <br />.__Acsording_tszCJ3~432.5-1 LfLpt_C.13.S. 3432-116, esch year,_on.the anniversary date of thepcrnit, an-0perator - <br />sha]1 submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be gerformed during the coming year, the dates For the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Picase attach your revised written annual report and annual report map to this form. The Anneal Report <br />& Fee requirement is not met until we have received the following components: fee. report. and associated <br />map. If no new disturbances or reclamation have occurred during_the nrevions veer and no new changes to <br />this in Lhe Annual Renort. Please note that an adeguutely Iabeted Wrap that Clearly detiaeares and includes <br />above elements may su~ee for a tvrittex report. <br />Division records indicate the following permittee contact information_ Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Bain <br />Per'mittee Name: Gail C. Allen and Mil]ie J. Allen <br />Address: P:6-Hex33 ) <br />- t~Ee ~ ~, lsr--r ~' O / O V <br />Limoer~e-808gff~ <br />Phone Number: (" O1 t-,~~ J/ 9~ 7'/~ - O/s' ~y <br />Pax Number-. (~-l~~a~899 (7/ 9~ 5 y y- 3 3 S g' <br />If you have additional comments andlor information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />/a /-7/a ~ <br />Date <br />