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Page 5 f 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or p int <br /> current contact information: <br /> Permittee Contact: R. Lewis Fillmore <br /> Permittee Company: R. Lewis Fillmore <br /> Address: P O Box 258 <br /> Boone, CO 81025 <br /> Phone Number: (719) 568-6712 <br /> Fax Number: <br /> Email Address: Ronfill@hotmail.com <br /> 1, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations a re <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> Signature of Permittee, Corporate Officer, Owner,or Documented Designee Date <br /> NI-AF-01 <br />