REP33535

• Permit No: M1987074
• IBM Index Class Name: Report
• Doc Date: 10/7/2002
• Doc Name: 2002 Annual Report
• From: Robert V Mayne
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REpUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Robert V Mayne
M-1987-074
Dotsero Quarry
October 9, 2002
RECEIVE®
OCT 0 7 2002

Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Eagle
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-[o-affected-land,
reclamation accomplished to date and during [he preceding year, new disturbances that are anticipated [o occur
during [he 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 [he year, if any.
Please attach vour revised written annual report and annual report map to this form. Please note that an
adequatel~~ labeled map that clearly delineates and includes the above elements may since for a wrinen report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Robert Mayne
Permittee Name: Robert V Mayne
Address: P.O. Box 175
Gypsum, CO 81637
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 instmctions are enclosed.
Signature of Corporate Officer, Owner, or Designee
Date
M:W ERMITU~ASTERDOCUMENTSVN-AF-01