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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />DGMC <br />M-1986-076 <br />Incas Mine <br />December 31, 2004 <br />$450.00 (Due on or before your anniversary date) <br />La Plata <br />.i.~ <br />DfC U t i~u4 <br />Rioisian of Minerals & Gaolopy <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, reclamation abbomplisned t6 date an3"duri~tg-the precedingycar,-ncy- disturbances-that-are anticipa±ed 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 xQur revised written annnal rennrt and annnal renurt m ~n to this 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: Jim Bender <br />Permittee Name: DGMC <br />Address: 5529 US Hwy. 64 <br />Farmington, NM 87401 <br />Phone Number: (505) 325-4065 <br />Fax Number: (505) 326-7542 FijX ~.SOS~-33 `~- ~ `+t z Z <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 />ature of C/orpor`at/e Officer, Owner, or Designee <br />Date ~ <br />M:NERMITUMASTERDOCUMENTS/M-AF-02.DOC <br />