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r <br />1\ <br />ANNUAL FEE an REPORT REQUEST <br />PERMITTEE NAME: Penn Mountain Mining Inc `"ECEIVED <br />PERMIT NO.: ?M-1985-022 AY 'I '12009 <br />OPERATION NAME: Bullger Basin Placer Di%4sioo of Rect;=tkm, <br />ANNIVERSARY DATE: May 23, 2009 - o W aW <br />ANNUAL FEE DUE: $$633.00 (Due on or before your anniversary date) <br />COUNTY: 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 affected <br />land, reclamation accomplished to date and3uriing the preceding year, iiewzii-stiirbances-thatare-antieipated-te <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 vour 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 may are necessary, then no new may is required 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 /> <br />Permittee Name: Penn Mountain Mining Inc <br />Address: 6182 S 2855 E <br />Ogden, UT 84403 <br />Phone Number: (801) 479-3754 <br />Fax Number: (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 />L) <br />Si ture of Corporate Officer, Owner, or esignee <br />Date <br />M:IPERMITIMA S TERDOC UMENT S/M-AF-02. DOC