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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: Stanley Thornburg <br /> Permittee Company: Thornburg Family Limited <br /> Partnership <br /> Address: 50747 E. 38 Avenue <br /> Bennett, CO 80102 <br /> Phone Number: (303)644-3424 <br /> Fax Number: <br /> Email Address: Jjvandeusen@hotmail.com <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 /> 9/y )�7/jz'12 <br /> Signature Permittee,Corporate Officer, ner,or Documented Designee Date <br /> M-AF-01 <br />