2017-08-18_REPORT - M2011029

• Permit No: M2011029
• IBM Index Class Name: REPORT
• Doc Date: 8/18/2017
• Doc Name: Annual Fee/Report/Map
• From: Jubilee Venture
• To: DRMS
• Annual Report Year: 2016
• Email Name: GRM
• 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: Martin R.Bauer
Permittee Company: JUBILEE VENTURE LLC
Address: 19754 E Euclid Dr
Centennial, CO 80016
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Martin R.Bauer �J C, f! A)Pr
Company: Jubilee Venture, LLC
Address: 19754 E Euclid Dr
Centennial, CO 80016
Phone Number: [phone]
Fax Number: [phone]
Email Address: a&) t usr A r
Inspection Contact: Martin R.Bauer
Company: Jubilee Venture,LLC
Address: 19754 E Euclid Dr
Centennial,CO 80016
Phone Number: [phone]
Fax Number: [phone]
Email Address: dm&f g.A)Wr'
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.
MWAI� V4117
Signatu a of Permitt<Cornorate Officer,Owner,or Documented Designee Date
M-AF-02