2009-02-23_REPORT - M1983011 - Laserfiche WebLink

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AQ -k Q?T ANNUAL FEE and REPORT REQUEST PERMTTTEE NAME: Jelen & Son, Inc. PERMIT NO.: M-1983-011 ".,/ OPERATION NAME: Willow Creek Mine ANNIVERSARY DATE: February 23, 2009 ANNUAL FEE DUE: $259.00 (Due on or before your anniversary date) COUNTY: Lake 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 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 attach your revised written annual report and annual report may to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated ma . If no new disturbances or reclamation have occurred durin the revious year and no clearly e new Chan es t the revious the Aar's may are nnual Re ortC Please note that an adequately labeled map thatOperator shall l state this in th y 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: Kay Blecha Permittee Name: Jelen & Son, Inc. Address: P.O. Box 103 Castle Rock, CO 80104 Phone Number: (303) 888-2507 Fax Number: (303) 286-8688 3,03 - z 9i- a'69'Y 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. Signature of Corporate Officer, Owner, or Designee`. FEB Z.3 2009 Date L Dwision of ReGamation, Mb" and Saf* M:\PERMI7IMASTERDMUMMISfWAF-02 DUC