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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 />RandySchafer <br />Permittee Company: <br />Phillips County <br />Address: <br />221 S. Interocean Ave <br />Holyoke, C080734 <br />Phone Number: <br />(970) 854-3778 <br />Fax Number: <br />Email Address: <br />Randy.schafer@phillipscounty.co <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 />M -AF -01 <br />0 <br />Owner, or Documented Designee Date <br />