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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: Jack Henris <br />Permittee Company: Cripple Creek & Victor Gold <br />MiningCom an <br />Address: 100 N. 3rd Street <br />P. O. Box 191 <br />Victor, CO 80860 <br />Phone Number: 719) 6894055 <br />Fax Number: 719) 689-3254 <br />Email Address: <br />Permitting Contact: Jack Henris <br />Company: Cripple Creek & Victor Gold <br />Address: 100 North Third Street <br />P.O. Box 191 <br />Victor, CO 80860-0191 <br />Phone Number: 719) 6894055 <br />Fax Number: 719) 689-3254 <br />Email Address: <br />Inspection Contact: Cheyne Mann <br />Company: Cripple Creek & Victor Gold <br />Address: 100 North Third Street <br />P. O. Box 191 <br />Victor, CO 80860-0191 <br />Phone Number: 719) 689-4048 <br />Fax Number: 719) 689-3254 <br />Email Address: Cheyne.mann@newmont.com <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 <br />IAC.AF4 2 <br />Owner, or Documented Designee