2013-09-18_REPORT - P2009025

• Permit No: P2009025
• IBM Index Class Name: REPORT
• Doc Date: 9/18/2013
• Doc Name: Annual Fee/Report/Map
• From: Black Range Minerals
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: TC1
• Media Type: D
• Archive: No

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19. As required by rule 5.6.1(f), attach a map to this report that accurately depicts the NOI boundary, current affected
area, location of all previously listed featured, and all acreages listed in items 6 through 12 and item 20. These
activities must be identified on a site map of adequate scale to field locate these areas, and may include coordinates in
latitude and longitude to at least 5 decimal places, or UTM coordinates with the datum and zone specified.
UPDATED MAP ATTACHED:
20. Rule 5.7 requires submittal of final abandonment reports within 60 days for any drill hole(s) with artesian flows and
no later than 12 months for all other completed drill holes.
ABANDONMENT REPORTS ATTACHED: o .. N /�
Division records indicate the following permittee /landowner contact information. If this information is not current, please
type or print current contact information: Rule 5.6.1(a, b).
Permittee Contact:
Patrick C. Siglin
Permittee Company:
Black Range Minerals
Address:
110 N. Rubey Drive, Suite 201
Golden, CO 80403
Phone Number:
(303) 279 -4946
Fax Number:
(303) 279 -4934
Email Address:
CF.PR.email
Landowner Contact:
Landowner Address:
Landowner Phone
Number:
Landowner Email
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in actor with the Division approved NOI and reclamation plans. Rule 5.6.1(h).
Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date