REP39058

• Permit No: M2001070
• IBM Index Class Name: Report
• Doc Date: 8/7/2002
• Doc Name: 2002 Annual Report
• From: Wallace F. Burtis
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

i _, --
ANNUAL FEE and REPORT REQUEST
RECEIVED
AUG 0 7 2002
Division of Minerals and Geology
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Wallace F. Burns
M-2001-070
Florence Pit
August 23, 2002
$225.00 (Due on or before your anniversary date)
Teller
According to C.R.S. 34-32.5-116 or C.k.S. 34-32-116, each year, on the anniversary date of the permit, an
- operatorshall submit [he annual-fee; a-report-and map showing-the extent of cursent-distcrbances-to affected- - -
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o
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 yeaz, if any.
Please attach vour revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements Wray suffice for a written
report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Wallace F. Burtis
Permittee Name: Wallace F. Burtis
Address: 66 Daztmouth Ave.
Pueblo, CO 81005
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to [he Division, please provide it
below or attach it [o this form along with your written report and map. Annual Report instructions are
enclosed.
~~ ~~~
Signature of Corporate Officer or Owner
Aacos> G. aeoi
Dat~
M:~PERMITNIASTERDOCUMENTS/M-AF-02. DOC