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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 />Jewelie Yetter <br />Permittee Company: <br />R & J Yetter Sand & Gravel <br />LLC <br />Address: <br />16757 CR 16 <br />Atwood, CO 80722 <br />Phone Number: <br />(970) 522-0867 <br />Fax Number: <br />Email Address: <br />Yetterjewelie@yahoo.com <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are <br />bein4 conducted in accordance with the Division approved mining and reclamation plans. <br />/ <br />L..)Q <br />J0 <br />SigfJtture of Permittee orate Officer, Owner, or Documented Designee Date <br />M -AF -01 <br />