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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 />Mark A. Steen <br />Permittee Company: <br />Gold Hill Mines, Inc. <br />Address: <br />957 Reynolds Farm Lane <br />Longmont, Co80503 <br />Phone Number: <br />(303) 651-2985 <br />Fax Number: <br />Email Address: <br />Goldtontine@gmail.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 />a..V— sA, Az r.�AT+Q4V—%kL#,4Q- ZS, Ao I5 <br />Signature ofPermittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -02 <br />