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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 />/ <br />Permittee Company: <br />Montrose County <br />Address: <br />949 N. 2nd Street <br />Montrose, CO81401 <br />Phone Number: <br />(970) 252-7000 <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 />being conducted in accordance with t e ' ion approved mining and reclamation plans. <br />( n- / /- �D // Z� <br />Signat e o ern fttee,—Corpor4 e O i r, Owner, or Documented Designee date <br />M -AF -04 <br />