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R:CEIVED <br />SEP 25 2015 <br />DIVISIvi. �-:—. i.e%MATION, <br />MINING -MINERAL8 <br />t�ORT 190" <br />printcurrent contact information: <br />Permittee Contact: I StanleyThornburg <br />rermmee %-ompany: I i nornourg r amuy i inntea <br />Address: 1 50747 E. 38 Avenue <br />Bennett, C080102 <br />Page 5 of a <br />Phone Number: <br />(303) 644-3424 <br />Fax Number: <br />Email Address: <br />Javandeusen(&,,hotmail.com <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 <br />NI -AF -01 <br />or Documented Designee <br />��. fie, l� - <br />ate <br />