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.~ <br />J <br />PERMITTEE NAME: <br />PERMTT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT 1ZEOUEST <br />Westley Potts <br />M-1983-030 <br />Twin Canyon Mine <br />June 10, 2002 <br />RECEIVED <br />MAY 1 3 2002 <br />Division of Minerals and Geology <br />$75.00 (Due on or before your anniversary date) <br />Montezuma <br />According [o 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 />onesatcir_ctaan_cithmik_t~ev_anwnal-faP--n-rPnFrt-ara~?-tnnn-ehn~.~inm-thr-e-trtrrt-rtf-rnrr~ nYtlisfitr}rtnr'..c-tn-affNt`rt~.r1 <br />land, reclamation accomplished to date and during the preceding yeaz, 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 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: Westley Potts <br />Permittee Name: Westley Potts <br />Address: 8115 CR 41 <br />Mancos, CO 81328 <br />Phone Number: (970) 533-7334 <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 [his form along with your written report and map. Annual Report instructions are <br />enclosed. <br />--~~g- --y~6 ~""""" <br />Signature of C1orporate Officer or Owner <br />.~ - ~/ ~ Gtr .~ <br />Dale <br />M:~PERMn1MASTERDOCUMENTS/M-AF-02. DOC <br />