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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: John Dietzler <br /> Perm ittee Company: Dietzler Construction Corporation <br /> Address: 5027 CR 37 <br /> Yoder, `W'Y 82244 <br /> Phone Number: 307-333-7552 <br /> Fax Number: 307-333-7554 <br /> Email Address: jdietzlerPdietzlerconstruction com <br /> I,the undersigned, hereby state that the information provided in this report is hue 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 Designee Date <br /> M-,F-as <br />