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<br />FiECEOVED <br />PERMITTEE 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 10,2003 <br />$75.00 (Due on or before your anniversary date) <br />Montezuma <br />MAY 1 5 2003 <br />Division of Minerals and Geology <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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected _ <br />land,, Teclamatton 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 your revised written annnal rennrt and annual report m ~n to this form. Please note that an <br />adequately labeled map that c/early 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: <br />Permittee Name: <br />Address: <br />Fax Number: <br />Westley Potts <br />Westley Potts <br />8115 CR 41 <br />Mancos, CO 81328 <br />-- U <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 />llU ~Q.~~\I-~ <br />Signature of Corpo to Officer, Owner, or Designee <br />~~ /~~- 03 <br />Date o <br /> <br />//~~ <br />~. <br />M:\PE RM ITVNASTERDOCUM ENTS/M-AF-02. DOC <br />