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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 />PhilDorenkamp <br />Permittee Company: <br />Las Animas County <br />Address: <br />2000 N. Linden Ave. <br />Trinidad, C081082 <br />Phone Number: <br />(719) 846-2931 <br />Fax Number: <br />(719) 846-0434 <br />Email Address: <br />Lasanimascounty@gmail.com <br />I, the undersjgned, hereby state that the information provided in this report is true and accurate, and that site operations are <br />being gon cted in accordance with the Division approved mining and reclamation plans. <br />Signature o(Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -04 <br />1 <br />We <br />