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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 <br />print current contact information: <br />Permittee Contact: <br />DavidP. Morlan <br />Permittee Company: <br />Rio Blanco County <br />Address: <br />570 2nd St. <br />Meeker, CO81641 <br />Phone Number: <br />(970) 878-9590 <br />Fax Number: <br />(970) 878-3396 <br />Email Address: <br />Dmorlan@co.rio-blanco.co.us <br />d A V . MQr 1 YA"j @ �.• kj C , J S <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 <br />M -AF -04 <br />Owner, or Documented Designee <br />Date <br />