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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: Jeff Sprague <br /> Permittee Company: JC Farms Inc <br /> Address: 55184 Co Rd ZZ <br /> Yuma, CO 80759 <br /> Phone Number: (970)630-0859 <br /> Fax Number: <br /> Email Address: Jcfarms1998@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 /> Signatur6 of Permittee, orporate Officer.Owner,or Documented Designee Date <br /> M-AF-01 / <br /> , <br />