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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: Alvin Mosch <br /> Permittee Company: Rocky West Mining Corp. c/o <br /> Alvin Mosch <br /> Address: P.O. Box 3244 <br /> Idaho Springs, CO 80452 <br /> Phone Number: (303) 567-0422 <br /> Fax Number: <br /> Email Address: <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 /> Signature of Permittee, Corporate Officer,Owner,or Documented Desilinee Date <br /> NI-AF-02 <br />