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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: Joe C. Baxter <br /> tZ Permittee Company: Kirkland Construction, R.L.L.P. <br /> Address: P.O.Box 580 <br /> Rye, CO 81069 <br /> Phone Number: (719)489-3385 <br /> Fax Number: (719)489-2265 <br /> Email Address: <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 /> 0-"� G.. � - ,/( <br /> Signa V <br /> of Permittee,Corpor to Offi er,Owner,or Documented Designee Date <br /> M-AF-01 <br /> RECEIVED <br /> ✓AUG 10 2016 �aa�-o3 DDIVISION <br /> MINING&OF REgAfECLAMATION, <br /> Q•(1 `r� i�0 v\VeX S <br /> � PORT MSS, D <br /> ���� <br /> � i <br />