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Division records indicate the following permittee contact information. If this information is not currentplease type o print <br />page 5 of 5 <br />current contact information: , <br />Permittee Contact: John Dietzler <br />Permittee Company: Dietzler Construction Corporation <br />Address: 5027 CR 37 <br />Yoder, WY 82244 <br />Phone Number: 307-333-7552 <br />Fax Number: 307-333-7554 <br />Email Address: <br />1, 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 />Va <br />a Zolvvner, or Documented Desi nee e <br />M -AF -04 <br />