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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this informat on is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Tim White <br /> Permittee Company: White Sand&Gravel,LLC <br /> Address: 7 N St Road <br /> Box 806 <br /> Elkhart,KS 67950 <br /> Phone Number: (620)544-9353 <br /> Fax Number: <br /> Email Address: Tcwhite@elkhart.com <br /> I,the undersigned,hereby state that the information provided in this report is true and ccurate,and that site operations are <br /> being conducted in accordance with the Division approved mining and reclamation pla s. <br /> O 'dam I Q&4Py", <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />