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Pagc 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 />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 accorg3Ae with the Diviss n approved mining and reclamation plans. <br />Signature of P r ittee CorgE Ar caner, or Documented Designee Date <br />AFAF-01 <br />