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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: Steve White <br /> Permittee Company: Montrose County <br /> Address: 949 N. 2nd Street <br /> Montrose, CO 81401 <br /> Phone Number: 9 <br /> Fax Number: <br /> Email Address: a„�p C �rrY. ► T <br /> SU,/.Ii7�a7 H <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 /> in dli I/X/ /& <br /> Sign re o ermittee, ornorate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />