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Page 5 of 5 <br /> <br />Division records indicate the following permittee contact information. If this information is not current, please type or pr int <br />current contact information: <br /> <br />Permittee Contact: <br /> <br />Douglas Brown <br />Permittee Company: <br /> <br />Fruita Development LLC <br />Address: <br /> <br /> <br /> <br />11990 San Vicente Boulevard, <br />Suite 200 <br /> <br />Los Angeles, CA 90049 <br /> <br />Phone Number: <br /> <br />(310) 806-9896 <br />Fax Number: (310) 806-9801 <br />Email Address: <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br /> <br />M-AF-01