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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: Don Marr <br /> Permittee Company: Yuma County <br /> Address: 1310 S.Blake St. <br /> Wray,CO 80758 <br /> Phone Number: (970)332-5718 <br /> Fax Number: (970)332-3429 <br /> Email Address: Yumacountyrb@gmail.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 /> 1 Z- ,� <br /> Ak- <br /> Signature of Permittee,Corvorate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />