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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: Gus Gaviotis' <br />Scott Pottorff <br />Permittee Company: Cotter Corporation <br />Address: P.O. Box 700 <br />Nucla, CO 81424 <br />Phone Number: 4-70)864-734-7- <br />970-773-4167 <br />Fax Number: <br />Email Address: Ius.gaviotis@cotterusa.com <br />dana.cline@cotterusa.com <br />Permitting Contact: tirtiggt <br />gus.gaviotis@cotterusa.com <br />Company: Cotter Corporation <br />Address: 7800 E. Dorado Place Suite 210 <br />Englewood,CO 80111 <br />Phone Number: 720) 554-6200 <br />Fax Number: 720)554-6201 <br />Email Address: <br />Inspection Contact: <br />Scott Pottorff <br />Company: Cotter Corporation <br />Address: 411140.e:-Dorado PraceSuite 210 <br />p0 Box 700Englucvcod, H-' <br />Nucla, CO 81424 <br />Phone Number: 0-554=62-00—.970-773-4167 <br />Fax Number: <br />Email Address: <br />dana.cline@cotterusa.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 />Signature of Permittee,Corporate Officer,Owner,or Documented Designee bat <br />M-AF-02