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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: Bob Basher <br /> Permittee Company: Delta County <br /> Address: 501 Palmer St Ste 227 <br /> Delta,CO 81416 <br /> Phone Number: (970)874-5914 <br /> Fax Number: (970)874-2455 <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 /> • <br /> Signature of Permittee f oruorate Officer,Owner,ordocumented D) Dat <br /> M-AF-04 <br />