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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: David Curtis <br /> Pemuttee Company: Oaklands Ranch <br /> Address: 1613 N Perry Park Rd <br /> Sedalia,CO 80135-8511 <br /> Phone Number: (303)688-4285 Z A <br /> Fax Number: (303)688-7957 <br /> Email Address: Oaklandsranch@netscape.net <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 ' _ ce with the Division approved mining and reclamation plans. <br /> 4///M <br /> Signature dWriniftee.Cornorate Officer,Owner.or Documented Designee Da e <br /> M-AF-0t <br /> 9 <br />