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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: Joann Vota <br /> Permittee Company: Jo Ann Vota <br /> Address: 315 N. Sunburst Ln. <br /> Durango,CO 81301 <br /> Phone Number: (970)259-1319 <br /> Fax Number: <br /> Email Address: S co bre5 Acz . kat <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 /> C4C' Ql � � 3c) -/ <br /> Signature of Permittee,Corporate Officer, Owner,or Documented Designee Date <br /> M-AF-01 / <br />