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<br />~EC~I!lir=® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />DGMC <br />M-1986-076 <br />Incas Mine <br />December 31, 2003 <br />DEC 0 5 2003 <br />Division rf Minerals and Geolom <br />$450.00 (Due on or before your anniversary date) <br />La Plata <br />According to C.R.S. 34-32.5-t 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an ' <br />operator-shah-submit-the-annual-fee,-a-report-and-map-shawing-thezxtent-of~urrent-disturbanc~s'ta affectez] <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 attac~yynnr revised written anneal report and annual re nP rt m ~n to this form- Please note thal an <br />adequately labeled map that clearly delineates and includes the above elements may since 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 />Permittee Name: DGMC <br />Address: 5529 US Hwy. 64 <br />Phone Number: <br />Fax Number: <br />Farmington, NM 87401 <br />(505)632-1276 <br />(505)326-7541 <br />cos-~z~-~syz~/ <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 />Sig re of Corporate Officer, Owner, or Designee <br />2~~ ~4~ <br />Date <br />M:\PERMIrUAASTER DOCUMENTS/M-AF-02. DOC <br />