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dL-z;,- <br />W <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />, <br />ANNUAL FEE and PORT REQUEST <br />n Mountain Mining Inc <br />?'2-'1985-022 <br />Bullger Basin Placer <br />May 23, 2010 <br />$$633.00 (Due on or before your anniversary date) <br />Park <br /> <br />Division of Reclamaiion, <br />Mining F? 3a fy <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-annue-l-fee-, a repe#-and--map-shw - ng-the ent-af.sLi-rrent-ZstL rbalr,??p--to-aff,ected- -- <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 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 changes to the previous year's map are necessary, then no new map 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: A <br />Permittee Contact: John?. Browning <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. n <br />of Coiporate Ofcer, Owner, or Designee <br />ZD%Q <br />Date <br />M: \PERMIT\MAS TERDOCUMENTS/M-AF-02. DOC