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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: Joseph C.Harden <br /> Permittee Company: Joseph Curtis Harden <br /> Address: P.O.Box 1207 <br /> Idaho Springs, CO 80452 <br /> Phone Number: (303)567-2259 <br /> Fax Number: <br /> N <br /> Email Address: NIA <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 /> Io—ZZ — 16 <br /> Sign ure of Permittee, Corporat Officer,Owner,or Documented Designee Date <br /> M-.AF-O'_ <br />