2017-06-01_REPORT - M2015028

• Permit No: M2015028
• IBM Index Class Name: Report
• Doc Date: 6/1/2017
• Doc Name: Annual Fee/Report/Map
• From: Teton Drilling Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• 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:
Mike Jones
Permittee Company:
Teton Drilling Inc.
Address:
PO Box 550
Henderson, CO 80640
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
Permitting Contact:
Mike Jones
Company:
Teton Drilling Inc.
Address:
10422 Heinz Way, Unit C
Henderson, CO 08064
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
Inspection Contact:
Mike Jones
Company:
Teton Drilling Inc.
Address:
PO Box 550
Henderson, CO 80640
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
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.
Signature of
NT- 4F-02
Owner, or Documented Designee
5- - 3o
Date