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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: Bi4y E.maek� <br /> Linda DeRose <br /> Permittee Company: Moffat County <br /> Address: P.O.Box 667 <br /> Craig,CO 81626 <br /> Phone Number: (970)824-3211 <br /> Fax Number: (970)824-0656 <br /> Email Address: <br /> Iderose@moffatcounty.net <br /> L 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 /> 17 <br /> h 09/13/2016 <br /> 4 ature of Permittee.Corporate Officer,Owner,6f Documented Designee Date <br /> M-AF-04 <br />