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112 Attachment <br />Permittee Name: Potco Mining & Milling <br />Operation Name: TIdIN CANON MINE/CT <br />Permit No: 83-30 <br />Anniversary Date: June 10 <br />Operator: <br />Please complete the foliowing and return this form with your fees and <br />reclamation data. <br />---fnclosed-are:-(Check-box(-es)-)----- - - - <br />I_I Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I-I Annual Report <br /> <br />I_I Map <br />Remarks: <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />