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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: 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: Caleb@colorosered.com <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 accordanc- with the ivision a•: oved mining and reclamation plans. <br /> i <br /> ///e/- <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />