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~_-~~~~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNiJAL FEE DUE: <br />COUNTY: <br />'Penn Mountain Mining Inc <br />M-1985-022 <br />Bullger Basin Placer <br />May 23, 2008 <br />u~l'~~~a~~~ <br />APR ~ 8 2008 <br />DI~J slop ua ~ cciarnation, <br />dining and Safety <br />$$633.00 (Due on 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 date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affecied- <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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's man are necessary, then no new map is reauired, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John V. Browning <br />Permittee Name: Penn Mountain Mining Inc <br />Address: 6182 S 2855 E <br />Phone Number: <br />Fax Number: <br />Ogden, UT 84403 <br />(801) 479-3754 <br />(801) 479-9410 <br />If you have additional comments and/or information that 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 />Signatu of Corporate fficer, Owner, or esignee <br />~ ] .~ s~~~ <br />Date <br />~I <br />M:~PERMITU~fASTERDOCUMENTS/M-AF-02. DOC <br />