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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: ROsS'}?eftrson /� r <br /> .4Jc'& `` L-C' �3"� A�� �4rSa� <br /> Permittee Company: Carder, Inc. . <br /> Address: R.(r. ' m I G � x ty i y ) <br /> 1110E 1 y y � <br /> Phone Number: <br /> \%s- ;6-)- 3S <br /> Fax Number: (719)336-0196 <br /> 3,G/ <br /> Email Address: <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Desi nee Date <br /> AI AF i <br />