2006-05-17_REPORT - M1983030

• Permit No: M1983030
• IBM Index Class Name: Report
• Doc Date: 5/17/2006
• Doc Name: Annual Fee/Report/Map
• From: Westley Potts
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

l ~?v12.
~~)
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
J~ ANNiiAi. FF.F. and RFPnRT RF,t7TTRST
j/ ,Westley Potts
M-1983-030
Twin Canyon Mine
June 10, 2006
$75.00 (Due on or before your anniversary date)
Montezuma
RECEI~:~E
MAY t l 2006
~Oivisien of Minerals and ;iau~ogy
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
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to _ _
occiai durmg the upcoming yeai, reclamation that will be performed during the coming year, the dates-for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach Xpnr revised written anneal re~nrt and annual rP,Pnrt m ~n to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Westley Potts
Permittee Name: Westley Potts
Address: 8115 CR 41
Mancos, CO 81328
Phone Number: [phone] _ -
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signa~tw~~e of Corpo ateate Off or Designee
-~- f'~ '_' ~ l0
Date o
M:~PERMITMASTERDOCUMENTS/M-AF-02.DOC