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III IIIIIIIIIIIIIIII <br />999 <br />ANNUAL FEE and REPORT REQUEST <br />13ECEIV~D <br />NOV ? ~. Lr~~ <br />PERMITTEE NAME: <br />PERMff NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Gold Eagle Mining, Inc. <br />M-1977.297 <br />Burros Mine <br />November 29, 2001 <br />$225.00 (Due on or before your anniversary date) <br />San Miguel <br />~ivis on of Minerals anJ Geology <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. Please Wore thnt an <br />adequately beled map that clearly efelineates mtd includes th above elements may sufltce for a written <br />repart. ~~ ~,/~ft.4~S ~,QpH C tJ~Fr7 ~ ~LC~ / <br />/ r- <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Coram <br />Permittee Name: Gold Eagle Mining, Inc. <br />Address: 845 E. Main St. <br />P.O. Box 3007 <br />Montrose, CO 81401 <br />Phone Number: (970) 249-0404 <br />Fax Number: (970) 240-3292 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach ~.,to this form along with your written report and map. Annual Report instructions are <br />Officer or Owner <br /> <br />A1.~PERMRVNASTERD(KUAIENTS/A1-AF-0? DOC <br />