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Page 5 of 5 <br /> <br />Division records indicate the following permittee contact information. If this information is not current, please type or pr int <br />current contact information: <br /> <br />Permittee Contact: <br /> <br />Ken Haynes <br />Permittee Company: <br /> <br />Grand County <br />Address: <br /> <br /> <br /> <br />P.O. Box 9 <br /> <br />Granby, CO 80446 <br /> <br />Phone Number: <br /> <br />(970) 887-2123 <br />Fax Number: (970) 887-3168 <br />Email Address: Khaynes@co.grand.co.us <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br /> <br />M-AF-04 <br /> <br />