REP52265

• Permit No: M1990147
• IBM Index Class Name: Report
• Doc Date: 2/9/2004
• Doc Name: Annual Fee/Report Notice
• From: Jack Pine Mining Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUN"CY:
Jack Pine Mining Company
M-1990-t47
Mendota Properties
February 12, 2004
FEB 0 9 2004
Division of Minerals and Geology
$225.00 (Uue 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 Cee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, 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 year, if any.
Please atfach~mir revised written annnal rennrt and annual re art mytp to this form. Please rro[e that an
adequately labeled reap that clearly delineates acrd rrrcledes the above elements may since far a written
report.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Permittee Contact: Fabyan Watrous
Permittee Name: Jack Pine Mining Company
Address: P. O. Box 66
Idaho Springs, CO 80452-0066
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 Corm along with your written report and map. Annual Report instructions are
enclosed.
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Signature orporate Officer,r~esigxue
Date
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