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Page 5 of 5 <br /> Division records indicate the following pennittee contact information. If this infonnation is not current,please type or print <br /> current contact information: <br /> Pennittee Contact: Chris Miller <br /> Pennittee Company: Ouray County <br /> Address: P.O. Box 456 ---- <br /> Ridgway,CO 81432 <br /> Phone Number: (970)626-5391 <br /> Fax Number: (970)626-4439 <br /> Email Address: Cmiller(i�ouraycountyco.gov <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 Designee Date <br /> NI-AF-04 <br /> ram^ <br /> �r aolC�> <br />