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0:13AL1 FR011-DIV RECLAUATIINV LIINING & SAFETY <br />T-621 P.003/003 F-346 <br />~ ANNIDAL FEE end i2EP0RT REQUEST ~~ <br />PERMITTEE ]NAME: ~ Gold Eagle MiaLrtB, Inc. REr"~1 p~~~ <br />PERMIT NO.: ~M-]977-297 ~~Q~ 2 Q ~o~s <br />OPERATION NAME: Bttrros Mine ~DIVMInin ci ~`"c'amation, <br />y and Safety <br />ANNIVERSARY DATE: November 29, 2006 <br />ANNUAL Pik DUE; $225.D0 (Due on or before your anniversary date) <br />COUNTY: Ssn Mlgacl <br />According to C,RS. 3432.5.116-or C:R.S. 34-3?•116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and trap showing the extent of cutmnt disturbances to affected <br />land, reclamation accomplished id date wad during tho preceding year, new disturbances that aze anticipated to <br />occur during the upcoming year, reclamation that will be performed daring the corning year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ~~~~* vised written annual report sad annual reoort man to this form. The Anneal <br />Report & Fee requirement is not met until we Lave received the following components: fee. reno~and <br />note than an <br />map that <br />Yt'1~ <br />j2,o1-~ <br />ss and Includes the above elements may suJftce jot a written report / <br />!~6•uCES t~if o/t c o,t~r.-,vT /~t/Fe~'.~~4?iu,~.~ t/ <br />.records indicate the following permiaee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Cotttm <br />3036326102 <br />Permittee Name: Gold Eagle Mining, Inc. l o~-/J EiFG ~E /!J i~ti~ 2,~ t/ <br />Address: 845 E. Main St. ~~ 7G R.~/it/C t^o u.~~ <br />P. O. Box 3D07 d a) 3e ° -7 <br />Montrose, CO 81401 ~ /'6wir~~ G ~'/ r~LO Z <br />Phone Number: <br />Fax Number: <br />(970) 249-04D4 <br />(970)240-3292 <br />97'0 -S9G•- ~2~Lr <br />970-.?u9 073 <br />If you have add' 'o mments and(or information that should be provided to the Division, please grovide it <br />below or attar s form along with your written report end map. Annual Rtpori instructions aze <br />enclosed. <br />Signature o Corporate Officer, Owner, or Designee <br />~ z lead <br />rate <br />