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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: Mary Kauffman <br /> Permittee Company: Jake Kauffman&Son,Inc. <br /> Address: 808 S. County Road 9E <br /> Loveland,CO 80537 <br /> Phone Number: (970)667-1557 <br /> Fax Number: (970)667-9985 <br /> Email Address: Kauffinan27@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 /> /7/71 / V-J-fritt4 <br /> Signature of ermi tee, "orate Officer, Owner,or Documented Designee Date <br /> M-AF-OI <br />