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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: Harry Covey <br /> Permittee Company: Harry Covey <br /> Address: 1600 Bain Dr. <br /> Erie, CO 80516 <br /> Phone Number: (303) 579-4538 <br /> Fax Number: <br /> Email Address: Mineralsofgold@aol.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 />