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ANNUAL End REPORT REQUEST <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~//Westley Potts <br />!/M-1983-030 <br />Twin Canyon Mine <br />June 10, 2007 <br />,~' <br />~ . <br />vt~^`I ?_ ~ 2QQ7 <br />DIV~si01': o...~~„o~~~~ion, <br />aping ano Safiety <br />$$75.00 (Due on or before your anniversary date) <br />Montezuma <br />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 <br />operator. halLsubmilshe~ual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated Yo -- <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach yonr revised written annual report and annual resort mao to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated mao. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact Westley Potts <br />,J ANJ tS 1''d //S <br />Permittee Name: Westley Potts ~ /q /1n /' S PO// ~ fD /t ~StL r~' Po// S <br />Address: 81 ]5 CR 41 '~//_~ Z~~~D /~ <br />N1NNCo5 co ~/3af~ <br />Mancos, CO 81328 <br />Phone Number: (970) 533-7334 ~17b ~ .~ 33 / ~ O 6 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~~ <br />Signa re of Corporate Officer, Owner, or Designee <br />~` //6 /v 7 <br />Date ~ <br />MiPERMITMASTERDOCUMEMS/M-AF-02.DOC <br />