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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: Stacy L. Quick <br /> Permittee Company: Cross Mountain Ranch Ltd. <br /> Partnership <br /> Address: P.O. Box 897 <br /> Craig,CO 81626-0897 <br /> Phone Number: (970) 824-2803 <br /> Fax Number: i <br /> Email Address: Stacyq@crossmountainranch.com <br /> 1, 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 /> 9, (�, Ick)AA <br /> 9 zq <br /> Signature of Permit a Corporate Officer,Owner,or Documented Designee Liate <br /> M-AF-O l <br />