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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 />Donald R. Hart <br />Permittee Company: <br />Donald R Hart <br />Address: <br />3500 Clear Fork Rd. <br />Crawford, CO 81415 <br />Phone Number: <br />(970) 921-5299 <br />Fax Number: <br />Ale <br />/Oha-P,. <br />77 <br />ha r1 e a <br />f/4X <br />Email Address: <br />Don@donsdirectory.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 ith e Lvision app .ved mi 'ng and reclamation plans. <br />-AL/a, Ad / <br />Signature o Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />tb, Date <br />