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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 />Al i d „ Q [ d 4,'' /� 6,7� <br />Permittee Company:ave <br />a <br />Address: <br />158 ffienwnUdl7r <br />Phone Number: <br />(594 -&34-894 —JO <br />Fax Number: <br />Email Address: <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 />MVO/-AF-01 <br />Owner, or Documented Designee <br />Date <br />