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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: Elaine Urie <br /> Permittee Company: Urie Rock Company <br /> Address: 2424 East Main Street <br /> Rangely, CO 81648 <br /> Phone Number: (970) 675-5766 <br /> Fax Number: (970)675-2013 <br /> Email Address: Elaine@urietrucking.com <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 wi he Division approved mining and reclamation plans. <br /> r " G <br /> Signature of Permittee r orate Officer,Owner,or Documented Designee Dad <br /> M-AF-01 <br />