Laserfiche WebLink
Page 5 of 5 <br /> <br />Division records indicate the following permittee contact information. If this information is not current, please type or print <br />current contact information: <br /> <br />Permittee Contact: <br /> <br />Mark Dorenkemp <br />Permittee Company: <br /> <br />Prowers County <br />Address: <br /> <br /> <br /> <br />109 E. Sherman St. <br /> <br />Lamar, CO 81052 <br /> <br />Phone Number: <br /> <br />(719) 336-5536 <br />Fax Number: (719) 336-9633 <br />Email Address: <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br /> <br />M-AF-04 <br /> <br />