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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 print <br />current contact information: <br />Permittee Contact: <br />Calvin Feik <br />Permittee Company: <br />Bent County <br />Address: <br />P.O. Box 350 <br />Las Animas, CO 81054-0350 <br />Phone Number: <br />(719) 456-2223 <br />Fax Number: <br />(719) 456-0375 <br />Email Address: <br />Bent.admin@bentcounty.net <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 <br />M -AF -04 <br />(4/;r /2a/S <br />Date <br />