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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: Cliff Henderson <br /> Permittee Company: Flying Triangle Ranch,LLC <br /> Address: 785 22 Road t `.L C' `, y <br /> Grand Junction,CO 81505 Q,•v e n..-ru 1-j <br /> Phone Number: (970)260-0892 1 <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 /> Sign a cf Permittee,Corporate Officer,Owner d Documented Designee Date <br /> M-AF-01 <br />