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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 />RobQuint <br />Permittee Company: <br />Logan County <br />Address: <br />315 Main St., Ste. 2 <br />Sterling, CO80751 <br />Phone Number: <br />(970) 522-7879 <br />Fax Number: <br />(970) 522-4018 <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 accordaj4 with the Division approved mining and reclamation plans. <br />40-Uata--- ?'I(q1�-ols- <br />Sicynature <br />nofPermittee, Corporate Officer, Owner, or Documented Desil4nee <br />M -AF -04 <br />ate <br />