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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: Jerry Nettleton <br /> Permittee Company: Peabody Williams Fork Mining, <br /> LLC <br /> Address: 29515 Routt County Road#27 <br /> Oak Creek,CO 80467 <br /> Phone Number: (970) 870-2712 <br /> Fax Number: <br /> Email Address: jettleton@peabodyenergy.com <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 acZe, o <br /> .th the Division approved mining and reclamation plans. <br /> Signature of Per ate O er wner,or Documented Designee Date <br /> M-AF-04 <br />