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ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: PCrystaIjack Mining <br />PERMIT NO.: A-1993-030 <br />OPERATION NAME: Crystaljack Mine <br />GMk e.9 k <br />D <br />/MAR 15 2010 <br />Division of Reclamation, <br />M'ming and Safety <br />-tv ANNIVERSARY DATE: April 26, 2010 <br />ANNUAL FEE DUE: $$86.00 (Due on or before your anniversary date) <br />COUNTY: Teller <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 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 may 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: <br />Permittee Contact: Joseph L. Dorris <br />Permittee Name: Crystaljack Mining <br />Address: 2920 Cedar Hts. Dr. <br />Colorado Springs, CO. 80904 <br />Phone Number: (719) 685-4479 <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 attac it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />S'gnature of Corporate Officer, Owner, or Designee <br /> <br />Date <br />M: \PERMITIMAS TE RDOC UMENT S/M-AF-02. DO C