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I ~J <br />ANNUAL FEE and REPORT REQUEST <br />APR 19 2002 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Wilbur F. Benham <br />M-1984-039 <br />Toltec No 2 <br />April 25, 2002 <br />RECElVEp <br />Division of Minerals and GealogY <br />$225.00 (Due on or before your anniversary date) <br />San Juan <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />=land; rec}amatiott°aecomplished=to'date°and°durng-tht:-preceding-year, new-disturbances-that-are-anticipated=io----- <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach vour revised written annual report and annual report map to this form. Please note that an <br />adequately Labeled map that clearly delineates and includes the above elements may suffice 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 />Pernuttee Name: Wilbur F. Benham <br />Address: 10195 S. Houghton Rd., #107 <br />Tucson, AZ 85747 <br />Phone Number: (520) 574-1016 <br />--Fax-Number:- ~%~~'7'G; _ - '- "` _ <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. _ ~1 <br />~K ~ G ~y yYiJ / ~~P Gnu l"'t ~~~ ? ~v ~~.c r ~hg N v i s % k r b .S*-~ C-cS <br />' /~Yeti•~.~r~ r,'~~ a.t> Re~~s~ Guy <br />~' ~/ (l ~!>• cK G Vcr bc~tdo n~ Co.~7T/n>~,c~~, <br />Signature of Corporate Officer or Ow er //o ~/ i i//~~~ Q 6~ :Z'~ d ~ ~ <br />Dale <br />M iPERMITVNASTERDOCUMENTS/M-AF-02.DOC <br />~GhY/il / <br />~i~~'®~ <br />~~~ ~^~~~os~~/c5 <br />~" <br />~~ cl Y /~ !"'9-`'fi }/'`kiwi <br />~'% <br />