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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 />Jot $41 c s /LI ✓ "'rri -7 <br />Permittee Company: <br />High Mountain Mining Co., <br />LLC <br />Address: <br />3040 S. Vallejo Street <br />Englewood, CO 80110 <br />Phone Number: <br />(303) 806-8487 <br />Fax Number: <br />(303) 806-9635 <br />Email Address: <br />O r r is i s o (-) 2_ e al 0 1 c p, <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 />In 16? rJ. ,194-, /-1,7 ( /— <br />Sign <br />Signafi re of Permittee, Corporate Officer, wner, or Documented Designee <br />M -AF -02 <br />/j i L C <br />� 6 <br />Da <br />