2017-02-03_REPORT - M2012032

• Permit No: M2012032
• IBM Index Class Name: REPORT
• Doc Date: 2/3/2017
• Doc Name: Annual Report Due Date Extension Request
• From: Ouray SIlver Mines Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: THM
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Clint Fletcher
Permittee Company: Ouray Silver Mines Inc.
Address: 1900 Main Street, Unit 564
Ouray, CO 81427 f 1900 Main St. Suite 1
Ouray, CO 81427
PO Box 564 Ouray, CO 81427
Phone Number: - - — -- — --- - - [phone] —„—� ---_
Fax Number: [phone]
Email Address: [e-mail] [e-mail] v
Permitting Contact: Clint Fletcher
Crystal Fletcher
Company: Ouray Silver Mines Inc. Ouray Silver Mines Inc.
Address: 1900 Main Street, Unit 564 1900 Main St. Suite I
Ouray, CO 81427
Ouray,CO 81427
PO Box 564 Ouray,CO 81427 v
Phone Number: [phone] [phone]
_ v
Fax Number: [phone]
Email Address: [e-mail] [e-mail]
Inspection Contact: Clint Fletcher
Crystal Fletcher �
Company: Ouray Silver Mines Inc. Ouray Silver Mines Inc.
Address: 1900 Main Street,Unit 564 1900 Main St. Suite 1
Ouray,CO 81427 Ouray,CO 81427
PO Box 564 Ouray, CO 81427 ✓
Phone Number: [phone] — [phone]
v
Fax Number: — [phone]
Email Address: [e-mail] [e-mail]
1,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.
(2-0-J-- " � a - i - I I
Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date
11t-AF-02