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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 print <br />current contact information: <br />Permittee Contact: <br />Justin Kuntz <br />Permittee Company: <br />Tim & Justin Kuntz Trucking, <br />LLC <br />Address: <br />53596 CR ZZ <br />Yuma, CO 80759 <br />Phone Number: <br />(970) 630-1462 <br />Fax Number: <br />Email Address: <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 />of <br />M -AF -01 <br />Owner, or Documented Designee <br />O Z� <br />Date <br />