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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: Jim Striggow <br /> Permittee Company: US, LLC <br /> Address: 4717 Bay View Drive <br /> Fort Collins,CO 80526 <br /> Phone Number: (970)221-1832 <br /> Fax Number: <br /> Email Address: Striggowrocks@frii.com X- <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 /> i <br /> Signature of Permittee, Corporate Officer,Owner,or Documented Designee ate <br /> M-AF-01 <br /> 41 <br /> � 1 <br /> 1 <br />