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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: Daren R. Stone <br /> Permittee Company: Daren Stone <br /> Address: P.O. Box 1568 <br /> Cortez, CO 81321 <br /> Phone Number: (970)882-3399 <br /> Fax Number: (970)882-3395 <br /> Email Address: Dkstone@outlook.com <br /> Permitting Contact: <br /> Company: <br /> Address: 17> <br /> Phone Number: <br /> Fax Number: LI <br /> Email Address: F) <br /> Inspection Contact: <br /> Company: Daren Stone <br /> Address: 24600 County Road"P" <br /> Dolores, CO 81323 <br /> Phone Number: }44"49. <br /> Fax Number: <br /> Email Address: <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 mining and reclamation plans. <br /> c � �0 <br /> Signature of Permittee or orate Officer, wner or Documented Designee Date <br /> M-AF-01 <br />