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&NF i- Qql- <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Sutherland Drilling <br />PERMIT NO.: M-1977-417 / ? OCT 2 6,,7M9 <br />OPERATION NAME: Sego Mine ?j Divi"n of RecW"tol9, <br />ANNIVERSARY DATE: November 1, 2009 t/ keft and Safety <br />ANNUAL FEE DUE: $259.00 (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 />-- - operator-shall-submit theannual-fee;-a report-and map showing- the-extent_of current disturbances-to-affected <br />, <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 vour revised written annual report and annual report map 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 chances to the previous vear's map are necessarv, then no new man 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: Bob Sutherland <br />Permittee Name: <br />Address: <br />Sutherland Drilling <br />P.O. Box 889 <br />Nucla, CO 81424 <br />Phone Number: (970) 864-7662 <br />Fax Number: <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 />-g'g? Signature of Corporate Officer, Owner, or Designee <br />QCT'n4ER Z2., 02009 <br />Date <br />M: \PERMIT?MASTERDOCUMENTS/M-AF-02.DOC