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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: Wayne R. Giesy <br /> Permittee Company: Midas Mining Company, Inc. <br /> Address: P.O. Box 772 <br /> Philomath,OR 97370 <br /> Phone Number: (541)929-4170 <br /> Fax Number: <br /> Email Address: <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 /> Signature of Pcrmittee,Corporate Officer,Owner,or documented Designee Date <br /> M-AF-02 <br /> r <br />