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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: Stephanie Tunstall <br /> Permittee Company: Eagle Peaks Mining LLC <br /> Address: 541 Cox Lane <br /> Howard,CO 81233 <br /> Phone Number: (719)942-4607 <br /> Fax Number: <br /> Email Address: StephsquartersG&yahoo.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 /> 'J <br /> Signature f Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> u-wr--oz <br />