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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: Jeannette J. Yaklich-Houston <br /> Permittee Company: Edward M. Yaklich <br /> Address: 1180 County Road 129 <br /> Westcliffe,CO 81252 <br /> Phone Number: (719)783-4700 <br /> Fax Number: <br /> Email Address: <br /> I,the unde ere state that the information provided in this report is true and accurate, and that site operations are <br /> being co nce with the Division approved mining and reclamation plans. <br /> 7M t' <br /> Signature of Permittee, Corpora fficer, er,or Documented Designee D to <br /> M-AF-01 <br />