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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: David Morlan <br /> Permittee Company: Rio Blanco County <br /> Address: 570 2nd St. <br /> Meeker, CO 81641 <br /> Phone Number: (970) 878-9590 <br /> Fax Number: (970)878-3396 <br /> Email Address: Dmorlan@co.rio-blanco.co.us 8 kV i8. rnt}rI a N <br /> @ Ybe. us <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 /> gnatu of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />