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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: Mary Kauffman <br /> Permittee Company: Jake Kauffman& Son,Inc. <br /> Address: 808 SCR 9E <br /> Loveland,CO 80537 <br /> Phone Number: (970)667-1557 <br /> Fax Number: (970)667-9985 <br /> Email Address: Kauffman27@msn.com <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 /> Signa�f Per i 'ee,Corporate icer,Owner,or Documented Designee Date <br /> M-AF-01 <br />