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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 />Patrick Mason <br />Permittee Company: <br />City of Lamar <br />Address: <br />102 E Parmenter St <br />Lamar, CO 81052 <br />Phone Number: <br />(719) 336-4495 <br />719 <br />- 3 3 Li — 1 <br />O `} <br />Fax Number: <br />(719) 336-4404 <br />Email Address: <br />Pat.mason@ci.lamar.co.us <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 />(H (` <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -04 <br />