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<br />4 <br />• ~II IIIIIIII~II~~ II~ , <br />999 <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Peuu Mountain Mining, loc. <br />M-1985-022 <br />Bullger Basio Placer <br />May 23, 2001 <br /> <br />RECEIVED <br />MAY 17 2001 <br />Division of Minerals and Ceolo9Y <br />$550.00 (Due o0 or before your anniversary date) <br />Park <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary daRe of the perniit, an <br />operator shall submit the annual fee, a report and map showing the extent of current dist rbances to affected <br />land, reclamation accomplished to date and during the preceding year, rew disturbznces tl'~at arc anticipated to <br />occur during the upcoming year, reclamation that will be performed during [he 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 note Thal an <br />adequately labeled map that clearly delbteates and includes [he above elements may SS~~ce for a ivrilten <br />report. <br />Division records indicate the following Pennittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: John V. Browning <br />Pennittee Name: Penn Mountain Mining, Inc. <br />Address: <br />Phone Number: <br />Fax Number: <br />6182 S. 2855 E. <br />Ogden, UT 84403 <br />C <br /> <br />(801)479-3754 <br />(801)479-9410 <br />If you have additional comments and/or information [ha[ should 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 />1 <br />Signatur f Corporate Officer or Ow r <br />~ .~/v/oi <br />ate <br />M.NERMITAfASn:RDOCUMEMS/M-AF-01 DOC <br />