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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 />MelanieBounds <br />Permittee Company: <br />Huerfano County <br />Address: <br />401 Main Street, Suite 105 <br />Walsenburg, CO81089 <br />Phone Number: <br />(719) 738-3000 <br />Fax Number: <br />(719) 738-3996 <br />Email Address: <br />I, the undersikned, hereby state that the information provided in this report is true and accurate, and that site operations are <br />being conducfpd in accordance with the Division approved mining and reclamation plans. <br />Owner, or Documented Desi„nee <br />M -AF -04 <br />Date <br />