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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: George Glasier <br /> Permittee Company: Pinon Ridge Mining LLC <br /> Address: P O Box 825 <br /> 31161 Highway 90 <br /> Nucla, CO 81424 <br /> Phone Number: (970) 864-2125 <br /> Fax Number: <br /> Email Address: Pinonridge.glasier@aol.com <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 /> Signature of Perm' ee Cor orate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />