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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: Amanda A. Anderson <br /> Pennittee Company: Amanda Adkins Anderson& <br /> Travis Anderson <br /> Address: P.O. Box 31268 <br /> Colorado Springs, CO 80911 <br /> Phone Number: (719) 568-0373 <br /> Fax Number: <br /> Email Address: Gtrvtano�a.ct.(e�2®�Sn ,CO <br /> 1,the undersigned,hereby state that the infonnation provided in this report is true and accurate,and that site operations are <br /> being conducted in accordance krafeOfficer, <br /> ivi ' oved mining and reclamation plans. <br /> i t of Permittee or Owner,or Documented Desince Date <br /> M-AF-02 <br />