2017-04-11_REPORT - M1978342

• Permit No: M1978342
• IBM Index Class Name: REPORT
• Doc Date: 4/11/2017
• Doc Name: Annual Fee/Report/Map
• From: Gold Eagle Mining
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Don Coram
Permittee Company: Gold Eagle Mining, Inc.
Address: P.O. Box 3007
Montrose, CO 81402
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Don Coram
Company: Gold Eagle Mining,Inc.
Address: P.O. Box 3007
1676 Rhine Court
Montrose, CO 81402
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Don Coram
Company: Gold Eagle Mining, Inc.
Address: P.O. Box 3007
1676 Rhine Court
Montrose, CO 81402
Phone Number: [phone]
Fax Number: [phone]
Email Address:
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being con cte accordance with the Division approved mining and reclamation plans.
�/ zC,/7
Signature 4 Permittee,Corporate Officer,Owner,or Documented Desitmee Date
M-AF-02