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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: Brian Lorch <br /> Permittee Company: Summit County Government and <br /> Town of Breckenridge <br /> Address: P.O. Box 5660 <br /> Frisco, CO 80443 <br /> Phone Number: (970)668-4067 <br /> Fax Number: (970)668-4225 <br /> Email Address: Brian.lorch@summitco.gov C / <br /> 6) <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 i ion approved mining and reclamation plans. <br /> _siature of P ee Corporate Officer,Owner,or Documented Desienee Date <br /> M-AF-04 <br />