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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: I Scott D. Hall <br />Permittee Company: Black Diamond Minerals, LLC <br />Address: 1600 Stout Street, Suite 1710 <br />Denver, CO 80202 <br />Phone Number: (303) 973-3228 <br />Fax Number: (303) 346-4893 <br />Email Address: Sdhall@bdminerals.com <br />D G1rI IC I 6- f- l f- T`L <br />/1, 4-C, y c f/c 1- A <br />'y6e1. -e Iri _t31v� <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 />C. <br />Signature of <br />til-nr•-oa <br />Owner, or Documented Designee <br />Date <br />