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r 4 • <br />Page 5 of 5 <br />Division records indicate the following permittee contact information. If this informatidn is not current, please type or <br />print current contact information: <br />Permittee Contact: <br />RonPeterson <br />Permittee Company: <br />Carder, Inc. <br />Address: <br />P.O. Box 732 <br />Lamar, C081052 <br />Phone Number: <br />7/9- t Y8 - 3 66 8 <br />iy <br />Fax Number: <br />4.11+9)-3464:144, <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 accordanceith the Division approved mining and reclamation plans. <br />Signature ofPermittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -OI <br />/02--,15---/ 5 <br />Date <br />