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Division records indicate the following permittee contact information. <br />print current contact information: <br />Page 5 of 5 <br />If this information is not current, please type or I <br />Permittee Contact: TonyF. Appelhanz <br />i <br />Permittee Company: Base Products <br />t <br />Address: 62339 W LaSalle Rd <br />Montrose, C081403 <br />Phone Number: 970) 249-3061 <br />Fax Number: 4 <br />Email Address: 06X e <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 Wermittee, Corporate Officer, Owner, or Documented Designee <br />Y-9--1is <br />Date