2001-12-20_REPORT - M1996049

• Permit No: M1996049
• IBM Index Class Name: Report
• Doc Date: 12/20/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

i
ANNUAL FEE and REPORT REQUEST
RECEIVED
iii iiiiiiiiiiiu iii
999
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
L.G. Everist Inc.
M-1996-049
Maryland Creek Ranch
December 20, 2001
DEC 2 0 2001

Diuislon of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Summit
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I l6, 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 tha[ 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 [he date active operations ceased for the year, if any.
Please attach vour revised written annual resort and annual resort mau to this form. Please note that an
adequately labeled map that clearly delineates and includes the above a/emer:ts may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contac[
Permittee Name
Lynn E. Mayer
L.G. Everist Inc.
Address: 7321 E. 88th Ave., Ste. 200
Henderson, CO 80640
Phone Number: [phone]
Fax Number: [phone]
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.
Signatur rate Officer or Owner
19-12-0~
Date
M:~PERA1rfN1A5TERD000M ENT5N1-AF~01