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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: Bob Sutherland <br /> Permittee Company: Sutherland Brothers,Inc. <br /> Address: P.O. Box 889 <br /> Nucla,CO 81424 <br /> Phone Number: (970)864-7f*6 <br /> 970 <br /> Fax Number: (970)864-7980 <br /> Email Address: Mardellsutherland@hotmail.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 /> f <br /> Signature f Permittee Corporate Officer,bwner,or Documented Designee Date <br /> M-AF-01 <br />