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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: Rebecca Hicks <br /> Permittee Company: Mt. Elbert Mining Co.,L.L.C. <br /> Address: 32460 Inverness Dr. <br /> Evergreen,CO 80439 <br /> Phone Number: (303)674-9669 <br /> Fax Number: (303)674-7775 <br /> Email Address: Seashellh@msn.com <br /> Permitting Contact: <br /> Company: <br /> Address: <br /> Phone Number: <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: <br /> Company: <br /> Address: <br /> Phone Number: <br /> Fax Number: <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 /> �2 7- <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />