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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 />Rex M. Hiner <br />Permittee Company: <br />R M Hiner Construction Co Inc <br />Address: <br />11 Austin Rd <br />Lamar, CO 81052-4301 <br />Phone Number: <br />(719) 336-3467 <br />Fax Number: <br />(719) 336-5031 <br />Email Address: <br />Rmhpipeconst@hotmail.com <br />rmhpipeconst@hotmail.com <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 />k,t(/ EJ 1k.,(� <br />January 17, 2016 <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -01 <br />