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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 />Ward Priestley <br />Permittee Company: <br />Hank Williams, Inc. dba <br />Williams Construction <br />Contractors <br />Address: <br />P 0 Box 704 <br />Norwood, CO 81423 <br />Phone Number: <br />(970) 327-4218 <br />Fax Number: <br />(970) 327-4157 <br />Email Address: <br />Ward@williamsconstruction.biz <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 />M -AF -01 <br />IZZ3--b- <br />e of Permittee Cor • orate Officer Owner, or Documented Designee Date <br />