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V <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />41 fi?4 r <br />AAN4LEE and REPORT REQUEST <br />Gold Eagle Mining, Inc. <br />11M-1977-297 <br />Burros Mine <br />November 29, 2010 <br /> <br />$518.00 (Due on or before your anniversary date) <br />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 the annual fee, a report and map showing the extent of current disturbances to affected <br />_ an, 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 chances to the previous year's may 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 />/,/0 Cr4IU6:? 11c, s <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Coram <br />Permittee Name: Gold Eagle Mining, Inc. <br />Address: P.O. Box 3007 <br />1676 Rhine Court <br />Montrose, CO 81402 <br />Phone Number: (970) 596-2425 <br />Fax Number: (970) 249-0731 <br />o?D -1, -/6'tt0 r-YiA C <br />PO 076K ;?6 0-7 <br />45 0G 11,,frJ A 0A D <br />W 1 G A/7.e cS 6 l g I d X40 z- <br />r 7 a 45'x' 6 -- A Y zs,. <br />y7? _c73/ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or a ch it this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />- j ((S eev-- <br />Signature of orporate Officer, Owner, or Designee <br />/,L A 0-/ C, <br />Date 11 <br />M:\PERlvIITkMASTERDOCUN ENTS/N4-AF-02.DOC