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Page 6 of 6 <br />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 />Patrick C. Siglin <br />< j <br />L Y-- f C <br />Permittee Company: <br />Black Range Minerals Colorado, <br />Landowner Phone <br />LLC <br />Number: <br />Address: <br />110 N. Rubey Drive, Suite 201 <br />9C <br />Golden, CO 80403 <br />P- C q e <br />Phone Number: <br />(303) 279-4946 <br />Fax Number: <br />(303) 279-4934 <br />) <br />/' tTl <br />Email Address: <br />Psiglin@blackrangeminerals.com <br />Landowner Contact: <br />< j <br />L Y-- f C <br />C �� <br />Landowner Address: <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 accordance with the Division approved NOI and reclamation plans. Rule 5.6.1(h). <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />P -AF -01 <br />Date <br />