2017-04-06_PERMIT FILE - M2017012

• Permit No: M2017012
• IBM Index Class Name: Permit File
• Doc Date: 4/6/2017
• Doc Name: Application
• From: Amazonite Mining, LLC
• To: DRMS
• Email Name: ERR
• Email Name: WHE
• Media Type: D
• Archive: No

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9. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit):
Contact's Name: JEFFREY S. FORREST Title: OPERATOR
Comnanv Name: AMAZONITE MINING, LLC
Street: 8057 S. VERMEJO PEAK P.O. Box:
City: LITTLETON
State: COLORADO Zip Code: 80127
Telephone Number: [ 303 1 _ 246-7819
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above):
Contact's Name: JEFFREY L. OTTEN Title: FIELD REPRESENTATIVE
Comnanv Name: AMAZONITE MINING, LLC
Street: 4175 COUNTY ROAD 5 P.O. Box:
City: DIVIDE
State: COLORADO Zip Code: 80814
Telephone Number: ! 719 ) _ 505-3576
Fax Number: ( 1 -
INSPECTION CONTACT:
Contact's Name: JEFFREY L. OTTEN -Title: FIELD REPRESENTATIVE
Company Name: AMAZONITE MINING, LLC
Street: 4175 COUNTY ROAD 5
P.O. Box:
city: DIVIDE
State: COLORADO
Zip Code: 80814
Telephone Number: ( 719 1 - 505-3576
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER if any):
Agency: U.S.D.A. FOREST SERVICE
Street: 320 HIGHWAY 285
City: FAIRPLAY
State: COLORADO
Zip Code: 80440
Telephone Number: ( 719 _ 836-3871
CC: STATE OR FEDERAL LANDOWNER if any):
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: S L -