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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 />Tim Kunau <br />Permittee Company: <br />Tim Kunau <br />Address: <br />23945 Lucky Ln <br />Calhan, CO 80808 <br />Phone Number: <br />(719) 683-3720 <br />Fax Number: <br />(719) 683-3717 <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 cnc ed inaccordancewith the Division approved mining and reclamation plans. <br />Signature of ermttee, CojYporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />1-1.--/6 <br />Date <br />