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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: Mark T. Bain <br /> Permittee Company: Bain Farms LLC <br /> Address: 1417 6th Street <br /> Limon, CO 80828 <br /> Phone Number: (719) 740-2363 <br /> Fax Number: <br /> Email Address: Bainmt@msn.com <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 /> S- <br /> Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-O 1 <br />