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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: Lynn Mayer Shults <br /> Permittee Company: L. G. Everist, Incorporated <br /> Address: 7321 E. 88th Ave., Ste 200 <br /> Henderson, CO 80640 <br /> Phone Number: (303)286-2247 <br /> Fax Number: (303)289-1348 <br /> Email Address: Lmshhults@lgeverist.com <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 /> 3 M11 7 /l� <br /> Signature o Permittee, Corporate Officer,Owner,or Documented Designee Da <br /> M-AF-O l <br />