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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: Joseph L.Dorris <br /> Permittee Company: Joseph L. Dorris <br /> Address: 2920 Cedar Heights Dr. <br /> Colorado Springs, CO 80904 <br /> Phone Number: (719)685-4479 <br /> Fax Number: <br /> Email Address: Gladier al pirinacle5minerals.com -J o e ("D?,,Ingc(,r 5 m;n e,'-,(�s . c� <br /> Permitting Contact: Joseph L.Dorris <br /> Company: Joseph L. Dorris <br /> Address: 2920 Cedar Heights Dr. <br /> Colorado Springs, CO 80904 <br /> Phone Number: (719)685-4479 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Joseph L.Dorris <br /> Company: Joseph L.Dorris <br /> Address: 2920 Cedar Heights Dr. <br /> Colorado Springs, CO 80904 <br /> Phone Number: (719)685-4479 <br /> Fax Number: <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 /> Signatu of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />