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Page 5of5 <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: Caleb Liesveld <br /> Permittee Company: Colorado Rose Red Inc. . <br /> Address: 148 Cheyenne Ct <br /> Lyons, CO 80540 <br /> Phone Number: (303) 823-6023 <br /> Fax Number: (303) 823-6023 <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />