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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: Ken Win kler <br /> Permittee Company: Montrose County <br /> Address: 949 N. 2nd Street <br /> Montrose, CO 81401 <br /> Phone Number: j2D <br /> Fax Number: <br /> Email Address: <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being co duct din accordance Division approved mining and reclamation plans. <br /> Sigx a of fermittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />