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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 />Margaret Hale <br />Permittee Company: <br />Margaret Hale <br />Address: <br />14480 N 74 Road <br />Montrose, CO 81401 <br />Phone Number: <br />(970) 249-5646 <br />Fax Number. <br />(970) 240-4164 <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 />Owner, or Documented Designee <br />H -AF -01 <br />Ita A5 <br />Da e <br />