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Page 5 of 5 <br />Division records indicate the following permittee contact inrormation. If this information is not current, please type or print <br />r�r t, contact information: <br />Permittee Contact: <br />Ray Anderson <br />Permittee Company: <br />Puckett Land Company <br />Address: <br />5460 S. Quebec St., Suite 250 <br />Greenwood Village, CO 801 l 1 <br />Phone Number: <br />(303) 763-1000 <br />Fax Number. <br />(303) 763-1040 <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 />, �'a / laza"41M If h1YA/V <br />Owner, or D Date <br />