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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: Brice F.Lee <br /> Permittee Company: Brice F Lee&Phyllis J Lee <br /> Address: 940 CR 119 <br /> Hesperus, CO 81326 <br /> Phone Number: (970)588-3369 <br /> Fax Number: (970)588-3369 <br /> Email Address: Brice@obii.net <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being conducte in acc rdance with the Division approved mining and reclamation plans. <br /> Sig re of ermittee Corporate Officer ,wne or Documented Designee Date <br /> M-AF-01 `- <br />