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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 />"149 <br />/Ony-P /^ <br />bet v e a <br />�/�� <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 P vision app •ved mi 'ng and reclamation plans. <br />/ o <br />Signature o Permittee, Corporate Officer, Owner, or Documented Designee Date <br />Pe /e,?oi <br />M -AF -01 <br />