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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: Cecil C.Powell <br /> Permittee Company: Cecil C Powell <br /> Address: P.O.Box 23 <br /> Dinosaur,CO 81610 <br /> Phone Number: (970)374-2329 <br /> Fax Number: <br /> Email Address: <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 /> ( 7s1/lc.�-- 4ru . e., c ef' �(/D del iroQ� -2L((:) <br /> Signat of P mittee,Corporate OffiEer Owner,or Documented d D ag nee Da <br /> M—AF-01 <br />