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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: Gil Moser <br /> Permittee Company: Gil Moser <br /> Address: 705 Crestview Dr. <br /> Farmington,NM 87401-9106 <br /> Phone Number: (505) 860-1728 <br /> Fax Number: (505) 564-9609 <br /> Email Address: cC)Shn°See-Q@, / <br /> G160.•Gben <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 /> ‘- � 0 <br /> Signature of Permittee,Corpora e Officer,Owner,or Documented Designee ate <br /> M-AF-02 <br />