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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />?, <br />AL FEi and ORT REQUEST <br />Westley Potts <br />-/M-1983-030 <br />Twin Canyon Mine <br />June 10, 2008 <br />$$86.00 (Due on or before your anniversary date) <br />Montezuma <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 accomplished to date and during the preceding-year, 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. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, an <br />associated map If no new disturbances or reclamation have occurred durin¢ the previous year and no <br />new changes to the previous vear's may are necessary, then no new may is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: James Potts <br />Permittee Name: Westley Potts <br />Address: 41375 Road H <br />Mancos, CO 81328 <br />Phone Number: (970) 533-7106 <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 this form along with your written report and map- Annual Report instructions are <br />enclosed. <br />Sign 45'e of Corporate Officer, Owner, or Designee <br />Date <br />M: PERMIT\MASTERDOCUMENTS(M-AF-02.DOC