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Page 4 of 4 <br />Division records indicate the following pennittee /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: <br />Mike Joosten <br />Permittee Company: <br />Mike Joosten <br />Address: <br />7775 E. 124th Dr. <br />Thornton, CO 80602 <br />Phone Number: <br />(720) 201 -0258 <br />Fax Number: <br />Email Address: <br />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 <br />Date <br />