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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 />Tom Brubaker <br />Permittee Company: <br />Valco, Inc. <br />Address: <br />9296 Windhaven Dr. <br />Parker, CO 81034 <br />Phone Number: <br />(303) 248-3590 <br />Fax Number: <br />(303) 248-3591 <br />Email Address: <br />Tom.brubaker@valco-inc.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 />- -- - &Ad-- <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -04 <br />[(-/D Zorn` <br />Date <br />