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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: Jay L.Wagner <br /> Permittee Company: Wagner Construction Inc. <br /> Address: 1850 E. 1st Street <br /> Craig,CO 81625 <br /> Phone Number: (970) 824-2709 <br /> Fax Number: (970) 824-2709 <br /> Email Address: <br /> I,the undersigned,hereby state that the infonnation 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 /> Sign re of Permi ee Cor orate Officer,Owner,or Documented Designee Date <br /> M-A- 1 <br />