2010-08-20_REPORT - M1984043

• Permit No: M1984043
• IBM Index Class Name: REPORT
• Doc Date: 8/20/2010
• Doc Name: Annual Fee/Report/Map
• From: Pelino, Inc
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNUAL FEE and REPORT REOUEST
Y
? Pelino, Inc.
M-1984-043 ,;
Jesse Lee
RECEW ED
AUG 2 0 20tU
ANNIVERSARY DATE: July 25,20 10
_ r
ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date)
COUNTY: Chaffee
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-dur-ing-the-upcoming year,-reclamation-that will be-perforaied-during the-coming yearthe4ates-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
ME;" ?.u ALLL'GJ Eu AMC; "AV, V ¦UE&3 V CaE A 1A&A" AE G Ely'-Vaaal V. ELLCLL EAU EIGn Ella Al EJ A Cl1 LLl¦ G4. {!l u V lIEGIE 111-1 AMU
Operator shall state this in the Annual Report. 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Scott Pelino
Permittee Name:
Address:
Pelino, Inc. _
P.O. Box 5049
33551,CR. 361
Buena Vista, CO 81211
Phone Number: [phone]
Fax Number: (719) -.? - L 1 3 15 (a 2 ,
If you ave additional comments and/or information that should be provided to the Division, please provide it
belo r attach i to this form along with your written report and map. Annual Report instructions are
encl d.
fR" Signature of Corporate Officer, Owner, or Designee
2y- lo?_
Date
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