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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 />Chris Miller <br />Permittee Company: <br />Ouray County <br />Address: <br />P.O. Box 456 <br />Ridgway, CO 81432 <br />Phone Number: <br />(970) 626-5391 <br />Fax Number: <br />(970) 626-4439 <br />Email Address: <br />Cmiller@ouraycountyco.gov <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 thDivision approved mining and reclamation plans. <br />t-5 AA <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -03 <br />�3 0� <br />Date <br />