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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: Kym A. Schure <br /> Permittee Company: Kym A. Schure <br /> Address: 12826 CR 37 <br /> Sterling,CO 80751 <br /> Phone Number: (970)520-6808 <br /> Fax Number: <br /> Email Address: Kymschure2000@yahoo.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 /> � 7 <br /> ig a re of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />