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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: Harry Covey <br /> Permittee Company: Harry Covey <br /> Address: i-690-B� 1+j q � g3 <br /> Eric;eO 8096 <br /> 1 <br /> &Uu A e-1-, C© a "3oZ <br /> Phone Number: (303)5794538 <br /> Fax Number: <br /> Email Address: r-('ids p W cw l f , <br /> Permitting Contact: Harry Covey <br /> Company: Harry Covey <br /> Address: 479 County Raod 83 <br /> Boulder,CO 80302 <br /> Phone Number: (303)442-0657 <br /> Fax Number: <br /> Email Address: m tit t e-CAJ So f Ot Q 0( c CO <br /> Inspection Contact: Harry Covey <br /> Company: Harry Covey <br /> Address: 479 County Road 83 <br /> Boulder, CO 80302 <br /> Phone Number: (303)442-0657 <br /> Fax Number: <br /> Pl- <br /> Email Address: Mineral lsnfgold@an1 ao <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 /> f '7 <br /> Signature of Per ttee Corporate fficer,Owner.or Documented Designee Date <br /> M-AF-02 <br />