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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: Sandra R.DuCray <br /> Permittee Company: Mountain Region Corporation <br /> Address: 117 29 3/4 Road <br /> Grand Junction,CO 81503 <br /> Phone Number: (970)242-5461 <br /> Fax Number: (970)242-6728 <br /> Email Address: Mtnregion@aol.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 /> f-Z3=24)/6 <br /> Signature of Permittee,Corpor :• Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />