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S - <br /> Page 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or prof <br /> current contact information: <br /> Permittee Contact: Bill Kobobel <br /> Permittee Company: Bill Kobobel <br /> Address: 7909 Weld County Road 5 <br /> Longmont,CO 80504 <br /> Phone Number: (303)591-0952 <br /> Fax Number: _(rom;p <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 Permittee,Corporate Officer Owner,or Documented Designee Date <br /> M-AF-01 <br />