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Page 5of5 <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: Patricia K. Coffee <br /> Permittee Company: Pueblo County <br /> Address: 33601 United Ave <br /> Pueblo,CO 81001 <br /> Phone Number: (719)583-4723 <br /> Fax Number: (719)583-4944 <br /> Email Address: Patcoffe@co.pueblo.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 /> 17464:, --441/)Signaturmittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />