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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 />Russell A. Larsen <br />S C-611 . beEnW /sE <br />Permittee Company: <br />4B Land & Livestock LLC ./- <br />Address: <br />Address: <br />556 Struthers Ave. <br />Craig, CO 81501-3826 <br />5e1 I-licaHwAy 399 <br />GeAtCa, Co 81(025 <br />Phone Number: <br />(970) 824-4767 V <br />Fax Number: <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 />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />1/.Or=Zoll <br />Date <br />