REP26427

• Permit No: M1985023
• IBM Index Class Name: Report
• Doc Date: 4/23/2002
• Doc Name: 2002 Annual Report
• From: Hollenbeck Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

P$RMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Hollenbeck, Inc.
M-1985-023
Hollenbeck Pit
May 6, 2002
$281.00 (Due on or before your anniversary date)
Gunnison
RECEIVED
APR 2 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-annual-fee;-a-report-and-map-showing-Yhe-exteni of-current-d7s[urbance"s to affec[ed-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 vour revised written annual report and annual report map [o this form. 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: Gene Hollenbeck
Permittee Name:
Address:
Hollenbeck, Inc.
P.O. Box 902
Gunnison, CO 81230
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 form along with your written report and map. Annual Report instructions are enclosed.
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Signature of Corporate Officer or Owner
Da~
M iPERMnN7ASTERD000MENTSUI-AF-01