2017-08-31_REPORT - M1978135HR

• Permit No: M1978135HR
• IBM Index Class Name: REPORT
• Doc Date: 8/31/2017
• Doc Name: Annual Fee/Report/Map
• From: Blue Jet Mining Inc
• 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
informatio-..on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Orvie Zimmerman
1
Permittee Company: Blue Jet Mining Inc �v
Address: P.O. Box 181
Craig, CO 81626 J
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Orvie Zimmerman r�
v
Company: Blue Jet Mining Inc g
V
Address: P.O. Box 181
Craig, CO 81626
Phone Number: [phone]
Fax Number:
Email Address: P-
Inspection Contact: Orvie Zimmerman
Company: Blue Jet Mining Inc
Address: P.O. Box 181
Craig, CO 81626
Phone Number: [phone] �a c/ S o y q
D's r
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.
Signature of Permittee,4Vrporate Officer,Owner,or Documented Designee Date
M-AF-02