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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: Justin Kuntz <br /> Permittee Company: Tim&Justin Kuntz Trucking, <br /> LLC <br /> Address: 53596 CR ZZ <br /> Yuma,CO 80759 <br /> Phone Number: (970)630-1462 <br /> Fax Number: <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 with the Division approved mining and reclamation plans. <br /> Sig ture of Permittee,Corp ate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> s s <br />