2015-09-04_REPORT - M1978135HR

• Permit No: M1978135HR
• IBM Index Class Name: REPORT
• Doc Date: 9/4/2015
• Doc Name: Annual Fee, Report & Map
• From: Blue Jet Mining
• To: DRMS
• Email Name: ACY
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
OrvieZimmerman
/
Permittee Company:
Blue Jet Mining Inc
i
Address:
P.O. Box 181
Craig, CO81626
p
Phone Number:
[phone]
Fax Number:
Email Address:
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.
O
Signature ofPermitta, Corporate Officer, Owner, or Documented Designee
M -AF -02
X311 S -
Date