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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 />Thomas E. Brubaker <br />Permittee Company: <br />Valco, Inc <br />Address: <br />9296 Windhaven Dr. <br />Parker, CO 80134 <br />Phone Number: <br />(303) 248-3590 <br />Fax Number: <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 conducted in accordance with the Division approved mining and reclamation plans. <br />to-J-A-dik <br />Signature of Permittee, Corporate Office, Owner, or Documented Designee Date <br />2-(' -uf6 <br />M -AF -04 <br />