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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 />Caleb Liesveld <br />Permittee Company: <br />Colorado Rose Red Inc. <br />Address: <br />148 Cheyenne Ct. <br />Lyons, CO 80540 <br />Phone Number: <br />(303) 823-6023 <br />Fax Number: <br />(303) 823-6023 <br />Email Address: <br />Caleb@colorosered.com <br />I, the undersigned, hereby state t <br />being conducted iq4 cordance <br />the info <br />the D <br />n provided in this report is true and accurate, and that site operations are <br />n approved mining and reclamation plans. <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -OI <br />rZ/Z/ S <br />Date <br />