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Division records indicate the following permittee/landowner contact information. If this information is not current, please <br />type or print current contact information: Rule 5.6.1(a, b). <br />Permittee Contact: <br />Thomas G. Miller <br />Permittee Company: <br />Thomas G. Miller <br />Address: <br />5260 Garrison St., #12 <br />Arvada, CO 80002 <br />Phone Number: <br />(303) 420-3606 <br />Fax Number: <br />(303) 420-3606 <br />Email Address: <br />Landowner Contact: <br />Landowner Address:d� <br />Landowner Phone <br />Number: <br />Landowner Email <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 NOI and reclamation plans. Rule 5.6.1(h). <br />Signature of Permittee, Corporate Officer, bwner, or Documented Designee <br />P -AF -01 <br />_/ _ �- <br />Date <br />