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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: James L.Treat <br /> Permittee Company: James L Treat <br /> Address: 225 G St <br /> Salida,CO 81201 <br /> Phone Number: (719)539-2215 <br /> Fax Number: (719)539-2588 <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 /> 1r-!l 117 <br /> SignatureA Permittee Cor orate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />