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Page 4 of 4 <br /> Division records indicate the following permittee/landowner contact information. If this information is not current,please <br /> type or print current contact information: Rule 5.6.1(a,b). <br /> Permittee Contact: Mike Joosten <br /> Permittee Company: Mike Joosten <br /> Address: 7775 E. 124th Dr. <br /> Thornton, CO 80602 <br /> Phone Number: (720)201-0258 <br /> Fax Number: <br /> Email Address: CF.PR.email <br /> Landowner Contact: <br /> Landowner Address: <br /> Landowner Phone <br /> Number: <br /> Landowner Email <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being conducted in accordance with the Division approved NOI and reclamation plans. Rule 5.6.1(h). <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br />