2017-05-12_REPORT - M1991054

• Permit No: M1991054
• IBM Index Class Name: REPORT
• Doc Date: 5/12/2017
• Doc Name: Annual Fee/Report/Map
• From: Indian Creek Mining
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• 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: Don Flickinger
Permittee Company: Indian Creek Mining Corp
Address: P.O. Box 350
Kodiak,AK 99615
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Rnbjc A1ex..Wer
Company: Indian Creek Min;,,a 'p
Address: 511 West Hall
Grand ,
Phone Number: (30 6$$--
Fax Number:
Email Address:
Inspection Contact: R
Company: Indi rroov r,i ft. . �� .
r
Address: 511 West Hall
Grand Junction, CO 81505
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.
f
Signature of Permittee Cor ora Officer.Owner,or Documented Designee Date
M-AF-02