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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: John and Brenda Higgins <br /> Permittee Company: Smithburg Family Partnership, <br /> LLLP <br /> Address: 27451 CR 3H <br /> Genoa, CO 80818 <br /> Phone Number: (719) 740-9350 <br /> Fax Number: <br /> Email Address: Jbhiggins@esrta.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 accordance with the Division approved mining and reclamation plans. <br /> Signature of Per mi ee,Corporate Officer,Owner or Docume ed Desi nee D to <br /> M-AF-01 <br />