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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: Marlene Crosby <br /> Permittee Company: Gunnison County <br /> Address: 195 Basin Park Dr. <br /> Gunnison, CO 81230 <br /> Phone Number: (970)641-0044 <br /> Fax Number: (970)641-8120 <br /> Email Address: <br /> mcrosb @ isoncounty.o 9 <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 /> 9/1 4/1 7 <br /> Si na re of Permittee Cor orate cer,Owner,or Documented Designee Date <br /> M-AF-04 <br />