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hCo <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~r <br />D/GMC <br />~I-1986-076 <br />Incas Mine <br />December 31, 2005 <br />RECEIVEa <br />~ncc ~ z zoo <br />~~~~ <br />$450.00 (Due on or before your anniversary date) <br />La Plata <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 th~ann~all'ee a report and >~ 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 yeaz, 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 xnnr revised written anneal re~nrf and anneal rennrt man 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: Jim Bender <br />Pennittee Name: DGMC <br />Address: 5529 US Hwy. 64 <br />Phone Number: <br />Fax Number: <br />Farmington, NM 87401 <br />(505) 325065 <br />(505)334-0422 <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 yotu written report and map. Annual Report instructions are <br />enclosed. <br />gnature of Corporate Of£cer, Owner, or Designee <br />Date <br /> <br />M:~PERMITMASTERDDCUMENTS/M-AF-02.DOC <br />