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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: <br />Michael T. Mordi <br />Permittee Company: <br />Routt County <br />Address: <br />P.O. Box 773598 <br />Steamboat Springs, CO 80477 <br />Phone Number: <br />(970) 870-5337 <br />Fax Number: <br />(970) 879-3992 <br />Email Address: <br />Mmordi@co.routt.co.us <br />Permitting Contact: <br />Paul H. Draper <br />Company: <br />Routt County <br />Address: <br />P.O. Box 773598 <br />136 6th St. <br />Steamboat Springs, CO 80477 <br />Phone Number: <br />(970) 879-0831 <br />Fax Number: <br />(970) 879-3992 <br />Email Address: <br />Inspection Contact: <br />William Rogers <br />Company: <br />Routt County <br />Address: <br />P.O. Box 773598 <br />136 6th St. <br />Steamboat Springs, CO 80477 <br />Phone Number: <br />(970) 879-0831 <br />Fax Number: <br />(970) 879-3992 <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 Divisiop4pproved mining and reclamation plans. <br />of Permittee, Coruorate Officer, Owner, or Documented Designee Date <br />M -AF -04 <br />