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~. <br />~ III IIIIIIIIIIIIIIII ~ <br />999 <br />110 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Westley Potts <br />M-83-030 <br />Twin Canyon Mine <br />06/10/88 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclos/ed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land <br />Division for annual fees due <br />i/ Annual Report <br />Remarks: <br /> <br />tion <br /> <br />Signature <br />(Rev. 02/88) <br />5257E <br />0052f <br />