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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: Jay Jutten <br /> Permittee Company: Lazy K-Bar Land&Cattle <br /> Company,LLLP <br /> Address: 70455 Buckhom Road <br /> Montrose,CO 81403 <br /> Phone Number: (970)249-6320 <br /> Fax Number: Q70 '( 52-- {G <br /> Email Address: Lazyk@montrose.net <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 /> Zi,i1t—" <br /> Si nat e o Permittee,Corporate Officer,Owner.or Documented Designee ate <br /> M-AF-01 <br />