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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: M. J.Cadgene <br /> Permittee Company: M J Cadgene <br /> Address: P.O. Box 10 <br /> Redvale, CO 81431 <br /> Phone Number: (970) 327-4694 <br /> Fax Number: (970)327-4694 <br /> Email Address: Mjctelluride@hughes.nct <br /> 1,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 /> —�kl Q 10 — //V <br /> Sign a of PerAttee.Corporate Officer,Owner,or Documented Designee D4te <br /> M-AF-01 <br />