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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: Forrest V. Luke <br />Permittee Company: Williams Fork Mining Company <br />Address: P.O. Box 187 <br />Craig, CO 81626 <br />Phone Number: 970) 826-6140 <br />Fax Number: 970) 824-6136 <br />Email Address: 4rfre54. e - ,Py,(,,, ",,;,\/0, f:....o xi i <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 he Division approved mining and reclamation plans. <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -0 1 <br />SDate/5-- <br />Date