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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 /> Permittee Company: Ru er <br /> Address: 949 N. 2nd Street <br /> Montrose, CO 81401 <br /> Phone Number: <br /> y 74-- J,sQ <br /> Fax Number: <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 /> 12,e,//0 <br /> a,��.✓L, Q d��✓ D u2 3 <br /> Sig a of ermittee,Corporate Officer,Owner,or Documented Designee D to <br /> M-AF-04 <br />