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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: Rick Ensminger <br /> Permittee Company: Rick Ensminger <br /> Address: P.O.Box 276 <br /> Haxtun,CO 80731 <br /> Phone Number: (970)774-6I08 <br /> Fax Number: c sl 1-0 --7-7 A , <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 /> Signature of Pormittee,Co rate Officer ,er or Documented Designee Date <br /> W.F.01 RECEIVED <br /> MAR 16 zo17 <br /> DIVISION OF R N MATION, <br /> ►� �� 10�036 <br />