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t <br />!~J <br />ANNIiAi. FF.F, and RF.PnRT RF.niTF,ST <br />R~~.~iV~ <br />PERMIT'T'EE NAME: Gold Eagle Mining, Inc. <br />PERMIT NO.: M-1978-342 FEB ~ f' ?Opy <br />OPERATION NAME: Ellison Mine O'r~s~0° °t Minerals <br />ANNIVERSARY DATE: February 15, 2004 °°tl~e°t°~y <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <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 />ouerator shall submit the annual fee, a report and m_ap 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 wilt 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 ynnr revised written anneal report and annual report man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: 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) 249-3292 <br />If you have additional comments and/or information that shou]d 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 />Signature of orporate Officer, Owner, or Designee <br />~~~~~~ <br />Date <br />M:IPERMINIASTERDOCUMEN'fS/M-AF-02.DOC <br />