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c <br /> 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: Wayne R. Giesy r M '7 11'e A., �— <br /> Permittee Company: Midas Mining Company, Inc. <br /> Address: P.O. Box 772 <br /> Philomath, OR 97370 <br /> Phone Number: (541)929-4170 <br /> Fax Number: <br /> Email Address: <br /> Permitting Contact: Wayne R.Giesy <br /> Company: Midas Mining Company, Inc. <br /> G uc iC i� <br /> Address: P.O. Box 772 <br /> Philomath, OR 97370 <br /> Phone Number: (541)929-4170 u•,✓�� <br /> Fax Number: (541)929-4174 �✓6 ct I[ <br /> Email Address: <br /> Inspection Contact: Les Charles <br /> Company: Midas Mining Company, Inc. J d r�,.��•�, , <br /> Address: 710 N. 1 Ith St. 7 Z <br /> Gunnison, CO 81230-2806 <br /> Phone Number: (970)641-2732 N r Gj y 1 9 2'3 tiro?� <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 /> g, I -17 <br /> Signature of Permittee,Corporate Officer,Ow r,or Documented Designee <br /> M-AF-02 <br /> SOZ> <br /> moor <br /> y-CD <br /> zy�N <br /> GN�n <br /> yZWrz <br /> -z0�� <br />