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~ ~ <br />PERMITTEE NAME: Wilbur F. Benham ~~~;~~~~® <br />PERMIT NO.: M-1984-039 APR 2 ~ 200y <br />OPERATION NAME: Toltec No 2 <br />ANNIVERSARY DATE: Apri125, 2004 ~fvisian of Minerals and Geology <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: San Juan <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 lyea~h_year, on_the anniversar, -date of thc-pem~it,-an <br />-ap~ator-shaYl"su miftlie annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written ann gal r p~nrt and anm~al report m ~n to Chic form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Wilbur F. Benham <br />Permittee Name: Wilbur F. Benham <br />Address: 10195 S. Houghton Rd., #107 <br />Tucson, AZ 85747 <br />Phone Number: (520) 574-1016 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Office Owner o <br />-~ o <br />Da~~ ~~ <br />S <br />M:~PERMITMAS7ERD000MENP$/M-AF-02.DOC <br />