2011-11-21_REPORT - M2005065

• Permit No: M2005065
• IBM Index Class Name: REPORT
• Doc Date: 11/21/2011
• From: Jack Clark Jr
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PER ITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FE DUE:
COUNTY:
RPr
ANNU F auwd RE RT REO•t7EST
V Jack Clark Jr.
M- 200B -O65
Upper Animas Sand and Gravel Pit
December 13
$323.00 (Due on or before your anniversary date)
San Juan
4116-06
NOV 2.1%Oil
Dtdiffiton of one
Mining & Safety
According to C.R.S. 34-325 -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 pertained during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Lease attach Vona revised ninon annual report and annual repel/ moo to this form. The Annual Report
& Fee requirement is not met until we have received the following eomponeut t fee. renerf, and aaaochated
MAE-
.1.l. • ILI I
_tees r !- ,
i 's
Petmlttee Contact Jack Clark Jr
Permittee Name: Jack Cleric Jr.
Address: P.O. Box 767
Date
Silverton, CO 81433
Phone Number: (970) 387
Fax Number:
eve
thilkthsAmdindat 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 penmittee contact information. Please verify and make any necessary
changes:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this fore~, along with your written report and reap. A,waual Report instructions arc enclosed.
4, •
of Corporate Officer, , or Des ignee