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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: Rob Quint <br /> Permittee Company: Logan County <br /> Eddress: 315 Main St., Ste.2 <br /> Sterling,CO 80751 <br /> Phone Number: (970) 522-7879 <br /> Fax Number: (970) 522-4018 <br /> Email Address: <br /> I, a undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> be conducted in ordance with the Division approved mining and reclamation plans. <br /> 0-(-1( ^ /1—/p Zo/. — <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Desince Date <br /> M-M-04 <br />