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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: Mike Bucklen <br /> Permittee Company: Bucklen Equipment Company, <br /> Inc. <br /> Address: 804 N 25th Ave <br /> Greeley, CO 80631 <br /> Phone Number: (970)353-0720 <br /> Fax Number: (970)353-0721 <br /> Email Address: <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 wit the Division a proved mining and reclamation plans. <br /> 7 I Z01 <br /> Signature of Permittee,Corpora re Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />