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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: Diana K.Watson <br /> Permittee Company: Diana K.Watson <br /> Address: P.O. Box 1056 <br /> Meeker,CO 81641 <br /> Phone Number: (970)629-0583 <br /> Fax Number: W Q)8 W 8 44� <br /> Email Address: // 1 <br /> G�LaJEiTs��h ,.. <br /> 1,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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />