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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: Gary C. Boyce <br /> Permittee Company: Gary C Boyce <br /> Address: 17425 CR 66T <br /> Moffat, CO 81143 <br /> Phone Number: (719)256-4613 <br /> Fax Number: <br /> Email Address: Gary@boycelc.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 /> -,-,v 0 -- Y/j z 1'0�' v6 <br /> Signature of Permittee,Corpora&Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />