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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: <br />Jim Striggow <br />Permittee Company: <br />US, LLC <br />Address: <br />4717 Bay View Drive <br />Fort Collins, CO 80526 <br />Phone Number: <br />(970) 221-1832 <br />Fax Number: <br />Email Address: <br />Striggowrocks@frii.com <br />1, 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;vvitfi tie Division approved mining and reclamation plans. <br />Signature of <br />MAF -01 <br />Officer, Owner, or Documented Designee <br />n <br />-"-Z7- <br />Date S. �' <br />