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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 /> Pennittee Contact: Nick H. Gray <br /> Permittee Company: Nick H.Gray <br /> Address: 584 65.30 Rd. <br /> Montrose,CO 81401 <br /> Phone Number: (970)249-9436 <br /> Fax Number: <br /> Email Address: <br /> I,the undersigned,hereb state that the information provided in this report is true and accurate,and that site operations are <br /> being conducted i co th the vision approved mining and reclamation plans. <br /> .5~ <br /> Sin Cor orate �cer,O er,or Documented Designee Date <br /> M-AF-01 <br />