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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: Scott Stewart <br /> Permittee Company: #17 Enterprises,LLC <br /> Address: 0275 CR 22 <br /> P.O. Box 88 <br /> DeBeque, CO 81630 <br /> Phone Number: (970)283-9420 <br /> Fax Number: (970)283-5227 <br /> Email Address: Sstewart@thehighlonesomeranch.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 /> Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />