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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 />Baxter Kirkland <br />Permittee Company: <br />Kirkland Construction, R.L.L.P. <br />Address: <br />P.O. Box 580 <br />Rye, CO 81069 <br />Phone Number: <br />(719) 489-3385 <br />Fax Number: <br />(719) 489-2268 <br />Email Address: <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 />C, <br />3 - 5, - v p/ t <br />Signatof Permittee, Corporate 0 ficer, Owner, or Documented Designee Date <br />M -AF -01 <br />