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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: Dale Schmidt <br /> Permittee Company: Dale and Ellen Schmidt <br /> Address: 472 Meadows Dr. <br /> Pagosa Springs, CO 81147 <br /> Phone Number: (970) 946-6262 <br /> Fax Number: <br /> Email Address: <br /> C F, emafL <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 ivision approved mining and reclamation plans. <br /> ..S a <br /> Signature ermittee,Corporate Officer,Owner,or Documented Designee D to <br /> M-AF-01 <br />