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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: Mark Kokes <br /> Permittee Company: MMM Partnership, LLP. <br /> Address: 15160 Hwy. 144 Lot 18 <br /> Fort Morgan, CO 80701 <br /> OC <br /> Phone Number: (970)867-3624 kk-� <br /> Fax Number: jo Fq Y, <br /> Email Address: Mdkokes@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 /> - W _ q — ,0 <br /> Signat a of Permittee,Coruorate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />