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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: Richard Fretterd <br />Permittee Company: Richard Fretterd <br />Address: 1065 Woodland Ave.,#16 <br />Woodland Park, CO 80863 <br />Phone Number: 719)687-0671 <br />Fax Number: <br />Email Address: Richardfretterd@peoplepc.com <br />Permitting Contact: <br />Company: Richard Fretterd <br />Address: 1065 Woodland Ave. #16 <br />Woodland Park, CO 80863 <br />Phone Number: 719)687-0671 <br />Fax Number: <br />Email Address: <br />Inspection Contact: Richard Fretterd <br />Company: Richard Fretterd <br />Address: 1065 Woodland Ave#16 <br />Woodland Park,CO 80863 <br />Phone Number: 719)687-0671 <br />Fax Number: <br />Email Address: <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 />1fZi/7SignatureofPermittee,Corporate Officer,Owner,or Documented Designee Date <br />M-AF-02