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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: 1 / <br /> Permittee Company: Connell Resources, Inc. <br /> Address: 7785 Highland Meadows Pkwy., <br /> Ste. 100 <br /> Fort Collins, CO 80528 <br /> Phone Number: (970)223-3151 <br /> Fax Number: (970)223-3191 <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 /> - L) It-1) Z 2 2,01r <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />