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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: Gregory A.Loop, <br /> Permittee Company: PK Enterprises,Inc. <br /> Address: 11115 W.Hwy. 24,Unit 2A <br /> P.O. Box 729 <br /> Divide, CO 80814 <br /> Phone Number: (719) 686-1566 <br /> Fax Number: (719) 687-6788 <br /> Email Address: <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 /> 1 )"'V- /��A, <br /> Signatur ermittee Corporate Officer, Owner,or Documented Designee D We <br /> M-AF-01 <br />