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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 /> L.1 R ?Fe <br /> Permittee Company: Fremont County <br /> Address: 1170 Red Canyon Road <br /> Canon City,CO 81212 <br /> Phone Number: <br /> �(71427-5-204-7--- <br /> C31 - 3-76 (7430 <br /> Fax Number: (719)275-2120 <br /> Email Address: <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 Per ttee, orporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />