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f <br />Page 5 of 5 <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />Permittee Contact: <br />EricB. Fenster <br />ADAM, !�-I&K- 050WO <br />Permittee Company: <br />120 85 LLC <br />Address: <br />10925 East 120th Avenue <br />Henderson, CO80640 <br />Phone Number: <br />('"'`� -;?1�a0 <br />3 LG R- 323 <br />Fax Number: <br />Email Address: <br />Erle@fe <br />0.Maad <br />sterlaw.net 1 <br />.0.5@ <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 mining and reclamation plans. <br />--7- tQ � <br />Si ure o-ffre-r-mittec,Corporate-'CKAkr, Owner, or Documented Designee Date <br />M -AF -01 <br />