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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: Mark Gardner <br /> Permittee Company: Ephemeral Resources,LLC <br /> Address: P.O.Box 1769 <br /> Grand Junction,CO 81502 <br /> Phone Number: (970)242-7538 <br /> Fax Number: (970)242-1851 <br /> Email Address: Whiteh2o@acsol.net <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 /> r 3 AV <br /> Signatu a of Permittee.Cdryorate Officer,Owner,or/Documented Designee Date <br /> M-AF-01 <br />