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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: <br />Rob Englehart <br />Permittee Company: <br />Montezuma County <br />Address: <br />1680 Noah Dolores Road <br />Cortez, CO 81321 <br />Phone Number: <br />(970) 565-8666 <br />Fax Number: <br />(970) 565-8252 <br />Email Address: <br />Road@montezuma.co.us <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 <br />m-AFAw <br />1010 Ito <br />Owner, or Documented Desianee Date <br />