2010-02-10_REPORT - M1990147

• Permit No: M1990147
• IBM Index Class Name: REPORT
• Doc Date: 2/10/2010
• Doc Name: Annual Fee/Report/Map
• From: Jack Pine Mining Company
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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AN AL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
J k Pine Mining Company
M-.1990-147
Mendota Properties
RECEIVED
;7E.-B 10 2010
Division of Reclamation,
Wining & Safety
February 12, 2010
$$259.00 (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
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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 your revised written annual report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or. reclamation have occurred during the previous year and no
new changes to the previous year's map ar•e necessary, then no new map is required, provided that the
Operator shall state this in the Annual Report. 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: FFaab/y'an Watrous,
Permittee Name: Jack Pine Mining Company
Address: P.O. Box 66
Idaho Springs, CO 80452-0066
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. Ga ??
Signature f Corporate Officer, Owner--,or EA

Date
M: TERMIT\MAS TERDOCUMENTS/M-AF-02. DOC