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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: Thomas Huerkamp <br /> Permittee Company: H/S Properties <br /> Address: 50 Heinz St. <br /> Delta,CO 81416 <br /> Phone Number: (970)874-8006 <br /> Fax Number: (970)874-3883 <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 /> a16� <br /> Signature of Permi tee, orgorate Officer, ner,or Documented Designee Date <br /> M-AF-01 <br />