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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: Josie Inlow <br /> Permittee Company: Flat Top Flagstone,LLC II 11 <br /> Address: 2135 City Gate Ln.,#420 2� �u SUSS <br /> Naperville,IL 60563 <br /> Phone Number: (331)472-3237 <br /> Fax Number: <br /> Email Address: Josie@fr-2.com <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 /> Sign ure of Per ittee,40orporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />