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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: Tom Brubaker <br /> Permittee Company: VALCO, INC. <br /> Address: 9296 Windhaven Dr. <br /> Parker,CO 81034 <br /> Phone Number: <br /> Fax Number: - <br /> Email Address: Tom.brubaker@valco-inc.com <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 /> 0111 -i-2Or6 <br /> -4 of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />