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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Harry Covey <br /> Permittee Company: Harry Covey <br /> Address: 1600-Buftr-0r.— Q`T <br /> , cad ter- Cry Ftj 3d z `� <br /> Phone Number: (303)579-4538 <br /> Fax Number: <br /> Email Address: c 1't'L t t1 p_!— $p G 0 (� �� c D►� <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 i accordance with the Division approved mining and reclamation plans. <br /> V71-17 <br /> Signa re of Permthee,Corporate Ofticer,Owner,or Documented Designee Date <br /> %I-AF-02 <br />