2004-05-25_REPORT - M1982075

• Permit No: M1982075
• IBM Index Class Name: Report
• Doc Date: 5/25/2004
• Doc Name: Annual Fee/Report/Map
• From: Alvin Mosch - Patricia Mosch
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMTITEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
RECEIVED
MAY 2 5 2004
Division ~f Minerals and Geology
Alvin Mosch -Patricia Mosch
M-1982-075
Phoenix Mine
June 14, 2004
$225.00 (Due on or before your anniversary date)
Clear Creek
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 yeaz, new disturbances t at are antrcrpated~to -'
occur during the upcoming yeaz, 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 ynnr revised written annnal report and anmral report mad 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 petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Alvin Mosch
Permittee Name: Alvin Mosch -Patricia Mosch
Address: Box 3236
Idaho Springs, CO 80452
Phone Number: [phone]
Fax Number:
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.
. `Y/~~
Signature of Corporate Officer, Owner, or Designee
~"-i4- o
Date

M:NERMIIIMASTERDOCUMENTSiM-AF-02.DOC