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Page 5 of 5 <br /> Division records indicate the following permitteeilandowner 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: - George Glasier <br /> Permittee Company: Pinon Ridge Mining LLC <br /> Address: P 0 Box 825 <br /> 31161 Highway 90 <br /> Nucla, CO 81424 <br /> Phone Number: (970)864-2125 <br /> Fax Number: <br /> Email Address: Pinonridge.glasier@aol.com <br /> Permitting Contact: George Glasier <br /> Company: Pinon Ridge Mining LLC' . <br /> Address: P 0 Box 825 <br /> 31161 Highway 90 <br /> Nucla, CO 81424 <br /> Phone Number: (970)864-2124 <br /> Fax Number: <br /> Email Address: Pinonridge.glasier@aol.com <br /> Inspection Contact: George Glasier <br /> Company: Pinon Ridge Mining LLC <br /> Address: P 0 Box 825 <br /> 31161 Highway 90 <br /> Nucla, CO 81424 <br /> Phone Number: (970)864-2124 <br /> Fax Number: <br /> Email Address: Pinonridge.glasier@aol.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 accordance with the Division approved mining and reclamation plans. <br /> --4e-c,--1 e____ .1/.42 illee'L ) PRZ:LS/AUVr %Yk-iege 02(-97 - <br /> Signature of Perm'0t7ee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />