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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 />Lynn Mayer Shults <br />R0 lc <br />Permittee Company: <br />L. Everist, Incorporated <br />Address: <br />7321 E. 88th Ave., Ste 200 <br />Henderson, CO 80640 <br />Phone Number: <br />(303) 286-2247 <br />Fax Number: <br />(303) 289-1348 <br />Email Address: <br />Lms$hults@lgeverist.com <br />�- <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 />Signature of <br />M -AF -01 <br />rate Officer, Owner, or Documented Designee <br />D to <br />