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Page 5 of 5 <br /> Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Fabyan Watrous <br /> Permittee Company: Jack Pine Mining Company <br /> Address: P.O. Box 66 <br /> Idaho Springs, CO 80452-0066 <br /> Phone Number: (303)567-2350 <br /> Fax Number: <br /> Email Address: Jpi-n��el:een� <br /> Permitting Contact: Fabyan Watrous <br /> Company: Jack Pine Mining Company <br /> Address: P.O. Box 66 <br /> Idaho Springs, CO 80452-0066 <br /> Phone Number: (W131-4i;tm <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Fabyan Watrous <br /> Company: Jack Pine Mining Company <br /> Address: P.O. Box 66 <br /> Idaho Springs, CO 80452-0066 <br /> Phone Number: <br /> Fax Number: <br /> Email Address: v <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 /> Signature of f0irmittee.Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />