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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: Kenneth L.Skoglund <br /> Permittee Company. Skoglund Excavating Inc. <br /> Address: 11 th and Broadway <br /> P.O.Box 209 <br /> Moffat,CO 81143 <br /> Phone Number. (719)256-4447 <br /> Fax Number: (719)256-4447 <br /> Email Address: Info@kenskoglund.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 /> 1,09 - Yz <br /> Signature of Permittee.Corporate Officer,Owner.or Documented Designee Date <br /> M•AF•01 <br />