Laserfiche WebLink
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 />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 pians. <br />of Permittee Corporate Officer Owner, or Documented Designee <br />M -AM <br />Date <br />