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4 <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 />FrankGilmore <br />Permittee Company: <br />Frank Gilmore <br />Address: <br />13721 G Road <br />Delta, C081416 <br />Phone Number: <br />(970) 874-5157 c, iMtt. <br />Fax Number: <br />Email Address: <br />�'oLKin vntl . Co <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 />% ZO I r <br />Signature ofPermittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -01 <br />