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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 />MikeMordi <br />Permittee Company: <br />Routt County <br />Address: <br />136 6th Street <br />P.O. Box 773598 <br />Steamboat Springs, C080477 <br />Phone Number: <br />(970) 870-5552 <br />Fax Number: <br />(970) 879-3992 <br />Email Address: <br />IM n <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 ivision approve mining and reclamation plans. <br />ofPermittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -04 <br />Date <br />