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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: Jim Sheridan <br /> Permittee Company: Cotter Corporation <br /> Address: P.O. Box 700 <br /> Nucla, CO 81424 <br /> Phone Number: (970) 864-7347 <br /> Fax Number: (970) 864-7287 <br /> Email Address: Jim.sheridan@cotterusa.com <br /> 1,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-02 <br />