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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 /> Permittte Contact: Rick L.Hunt <br /> Permittee Company: Rick L Hunt <br /> Address: 43160 County Rd 17-21 <br /> Elizabeth,CO 80107 <br /> Phone Number: (303)646-6486 <br /> Fax Number: (303)646-9233 <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 /> (\o n SV\AArf'OU ,`S I AV Q o�- $e'n y-') $19 116 <br /> Slinature of Permiittee,Corporate Officer,Owner or Documented Designee Date <br /> M-AF-01 <br />