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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: Kelly Kardos <br /> Permittee Company: XTO Energy Inc. <br /> Address: P.O. BOX 6501 <br /> ENGLEWOOD,CO 80155 <br /> Phone Number: (303)397-3727 <br /> Fax Number: (505)213-0456 <br /> Email Address: Kelly_kardos@xtoenergy.com <br /> 1,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 /> (D I a III <br /> Signature of P6inittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />