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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 />Richard L. Wamsley <br />Permittee Company: <br />Richard L Wamsley dba- RLW <br />Enterprises <br />Address: <br />3465 County Road 11 <br />Walden, CO 80430 <br />Phone Number: <br />(970) 723-4353 <br />Fax Number: <br />(970) 723-4353 <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, Cd"fporate Officer, Owner, or Documented Designee Date <br />/1- <br />M -AF -01 <br />1 - <br />M -AF -OI <br />