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PERMTTTFP. NAME_ Blue Jet Mining Inc n 7(111 <br />PERMIT NO.: /M-1978-135-HR <br />OPERATION NAME: Blue Jet Mine ciy Division 01 i :(,-,020 - 0 ,00,,, <br />mining en d saleti <br />ANNIVERSARY DATE: September 9, 2011 <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 />operat ial-fee,a_report_and-map_shawing-the-exterit-of-current-disturhances 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 durine the previous year and no <br />new chanaes 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 />Permittee Contact: O Zimmerman <br />Permittee Name: Blue Jet j ming Inc <br />Address: P.O. Box 181 <br />Craig, CO 81626 <br />Phone Number: (970) 824 -5049 <br />Fax Number: <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 />LG� <br />Signature o orporate Officer, Owner, or Designee <br />7 //a /2o'/ <br />Date <br />M: IPERMETIMASTERDOCUMENTS /M AF 02 .DOC <br />ANNUAL FEE and REPORT REQUEST <br />�v o mt., N (3 E <br />