REP38046

• Permit No: M1987092
• IBM Index Class Name: Report
• Doc Date: 7/9/2002
• Doc Name: 2002 Annual Report
• From: Jordan C. and Jone L. Burdick
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
JUL 0 9 2002
PERMFFTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Jordan C. and Jone L. Burdick
M-1987-092
B & G Stone
August 25, 2002
RECEIVE®
Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Latimer
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 sa6mit the annual"fee, a report and map showing fhe extent-of current-disturbances-to affected land---~
reclamation accomplished to date and during the preceding yeaz, 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 resort map to 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: Jordan C. Burdick
Permittee Name: Jordan C. and Jone L. Burdick
Address: P.O. Box 1385
Lyons, CO 80540
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 aze enclosed.
S/ig~nature of Corporate fficer or Owner
/ ' ~ ~ ©~
Date
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