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Page 5 of 5 <br /> <br />Division records indicate the following permittee contact information. If this information is not current, please type or print <br />current contact information: <br /> <br />Permittee Contact: <br /> <br />John Dietzler <br />Permittee Company: <br /> <br />Dietzler Construction Corporation <br />Address: <br /> <br /> <br /> <br />5027 CR 37 <br />Yoder, WY 82244 <br /> <br />Phone Number: <br /> <br />307-333-7552 <br />Fax Number: 307-333-7554 <br />Email Address: jdietzler@dietzlerconstruction.com <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br /> <br />M-AF-04 <br /> <br />