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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 />Roy Hocker <br />Permittee Company: <br />Hocker Construction, LLP <br />Address: <br />P.O. Box 627 <br />Ignacio, CO 81137 <br />Phone Number: <br />(970) 563-9533 <br />Fax Number: <br />Email Address: <br />Roy@HockerConstruction.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 conduces' accordance with the Division approved mining and reclamation plans. <br />V"i <br />Signature of Peritee, Corporate Officer, Owner, or Documented Designee <br />M -AF -OI <br />Date <br />