2003-01-27_REPORT - M1990147

• Permit No: M1990147
• IBM Index Class Name: Report
• Doc Date: 1/27/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Jack Pine Mining Company
M-1990-147
Mendota Properties
February 12, 2003
~ECEAVED
JAN 2 7 2003
Division of Minerals and Geology
$225.00 (Due on or before your anniversary date)
Clear Creek
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 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 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 ynnr revised written annnal rennrt and annnal rennrf marn m [his form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Fabyan Watrous
Permittee Name: Jack Pine Mining Company
Address: P.O. Box 66
Idaho Springs, CO 80452-0066
Phone Number: [phone]
Fax Number: (~ O 3} S L 7-13s ~
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.
Signature o Corrorate Officer, ®vmer, or-e ' J ~~ ,
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Dale
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M:~PERMITMASTERDOCUMENTS/M-AF-02.DOC