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Page 5 of <br /> Division records indicate the following permittee contact information. If this information is not current,please type or print <br /> current contact infannation: <br /> Pennittee Contact: -.-- Daniel J.-Gaudreault <br /> Pertnittee Company: Daniel J. Gaudreault and <br /> Barbara J. Gaudreault <br /> Address: P.G. Box 69 <br /> Elizabeth,CO 80107 <br /> Phone Number: (303)435-3081 <br /> Fax Number: (303)646-1451 <br /> Email Address: Danbarbg2,kaol.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 with the Division approved training and reclamation plans. <br /> Signature of rmittee Cor orate Officer,Owner,or Documented Designee c <br /> RECEIVED <br /> MAY 10 2017 MAY ?017 <br /> DIVISION OF RECLAMATION DIVISIC <br /> MINING&SAFETY <br /> M' <br />