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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 />Billy E. Mack <br />Permittee Company: <br />Moffat County <br />Address: <br />P.O. Box 667 <br />Craig, CO 81626 <br />Phone Number: <br />(970) 824-3211 <br />Fax Number: <br />( 970 ) 824-0356 <br />Email Address: <br />bmack@moffatcounty,net <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 />_.f.. /I14,ec <br />-1/26/2016 <br />Signature Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -04 <br />