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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 />Bob Basher <br />Permittee Company: <br />Delta County <br />Address: <br />501 Palmer St Ste 227 <br />Delta, CO 81416 <br />Phone Number: <br />(970) 874-5914 <br />Fax Number: <br />(970) 874-2114 <br />Email Address: <br />6 6A5ac-k' 1 !%v-t7n(t*6,w7`y. C ekro <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 />/iy <br />Signature of Permittee, Corporate Officer, Owner, o ocumented Designee bate' <br />M -AF -04 <br />