REP38943

• Permit No: M1995030
• IBM Index Class Name: Report
• Doc Date: 6/13/2002
• Doc Name: 2002 Annual Report
• From: Green Brothers Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Green Brothers, Inc.
M-1995-030
Green Bros Pit No 2
July 7, 2002
$281.00 (Due on or before your anniversary date)
Morgan
RECEIVED
JUN 1 3 2002
Division of 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 annrial fee; a repof~and_inap_showing--the extent of current--disturbances to_affected_land,
reclamation accomplished to date and during the preceding yeaz, 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 yeaz, if any.
Please attach your revised written annual report and annual report map to this form. Please note that an
adequately labeled trap 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: Jim F. Green
Permittee Name: Green Brothers, Inc.
Address: 19441 U.S. Hwy. 34
P.O. Box 858
Ft Morgan, CO 80701
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.
1/`~
S gnature of Corporate Officer or Owner
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