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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: Bernard Frei <br /> Permittee Company: Albert Frei& Sons Inc. <br /> Address: P.O.Box 700 <br /> Henderson,CO 80640 <br /> Phone Number: (303)289-1837 <br /> Fax Number: (303)289--X655 b 5 <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 /> Secretary <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> Note: <br /> Review attached page for details on current <br /> mine status and activities <br /> Albert Frei and Sons,Inc-Hatchery Pit 2016 <br />