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pvp i- lZf-r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Blue Jet Mining Inc / NF <br />PERMIT NO.: M-1978-135-HR AUK 18 Z010 <br />Divislon <br />OPERATION NAME: Blue Jet Mine kinin9 and 3a eatk,,,, <br />ANNIVERSARY DATE: September 9, 2010 tY <br />ANNUAL FEE DUE: $259.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map-showing the-extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanp-es to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Orvie Zimmerman <br />Blue Jet Mining Inc <br />Address: P.O. Box 181 <br />Craig, CO 81626 <br />DILI ,.Ta h - 0 g , o - S? yA s o y 9 <br />Pax Numb-r. -IA-22.24 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Co rate Officer, Owner, or Designee <br />Date <br />M:IPEFNHTI ASTERDOCUMENTS/M-AF-02.DOC