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_ • iiiiiiiiiiiiiiii-iii • ~ <br />• ~ ANNUAL REPORT ~ ~~ <br />PERMITTEE NAME: Westley Potts ~~ ~j <br />PERMIT NO.: M-83-030 <br />OPERATION NAME: Twin Canyon Mine* ~~ <br />ANNNERSARY DATE: June 10, 1999 ,~FCEIVED <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $75.00 APR 2 8 ~gg9 <br />COUNTY: Montezuma <br />u,v„ gun or Minerag & Geoto9Y <br />Accurding [o C:R:S: 34=32-i lti(3)~aj, 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 <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during [he coming year, the dates for [he beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that mr adequately labeled map thnt clearly delineates mid <br />includes the above elements mny since for n tivritten report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: W e S 1 ) e y PD7r~5 Company: }~o~Co ~'~'P /err l >, ~ °~~~~ 1 1 ~~ <br />Address: fs ll,h~ ~ y~ Phone No.: ( 97y) X533-733 y <br />~~ ~'Yt !',n 5 CO t~'(3oZb- Fax No.: <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach i[ to this report form along with your map and/or <br />written report. <br />Signature of or rate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />