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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: Ed Benson <br /> Permittee Company: Benson Brothers <br /> Address: 21240 Austin Rd <br /> Austin, CO 81410 <br /> Phone Number: (970)835-3128 <br /> Fax Number: (970)835-8567 <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 /> Sigfnature of Permittee,Como ate Officer,Owner,or Documented DesiEnee Date <br /> M-AF-01 <br />