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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: Travis Sackman <br />Permittee Company: Sako Excavation, LLC <br />Address: 1254 County Road 23 <br />P.O. Box 1103 <br />Ouray, CO 81427 <br />Phone Number: 970) 325-0459 <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 />bein z conducted in accordance with the Division approved mining and reclamation plans. <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -A F-0 t <br />Date