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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: Michael D. Shumway <br /> Permittee Company: Liberty Mining,LLC <br /> Address: 1300 South Highway 191 <br /> P.O. Box 1032 <br /> Moab,UT 84532 <br /> Phone Number: (435)259-2333 <br /> Fax Number: (435)259-9864 <br /> Email Address: r-• �'4b Cri o A-, <br /> C-C'" A b ( ' Jv r.,V+,F;.'lt--<l <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 /> 42&t�ji 140-nce- glZ(o) Ia <br /> Signature 4Pe'rmitlee,Corporafe Officer,Ow ,or Documented Designee Date <br /> M-AF-02 <br />