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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 />Raymond C. Petersen <br />Permittee Company: <br />Raymond C. Petersen <br />Address: <br />P.O. Box 832 <br />Kremmling, CO 80459 <br />Phone Number: <br />(970) 724-9327 <br />Fax Number: <br />(970) 724-9327 <br />Email Address: <br />Coriverranch@gmail.com <br />/ <br />C.OYiVerrc1!M <br />q mai /. Cons <br />āœ“ <br />J <br />1 <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 />..11/eā€ž //4 <br />Signa re of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -O I <br />