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i <br /> 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: Steve Baker <br /> Permittee Company: 3B Enterprises,LLC <br /> Address: P.O.Box 1665 <br /> Craig,CO 81626 <br /> Phone Number: (970)824-0225 <br /> Fax Number: <br /> Email Address: <br /> +11+- benttxP yahoo cpm <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 Divi: on approved mining and reclamation plans. <br /> 1 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />