Laserfiche WebLink
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 />Peiuiittee Contact: <br />Timothy D. Williams <br />Permittee Company: <br />Timothy D. Williams & Betty J. <br />Williams <br />Address: <br />5588 CR 210 <br />Walsenburg, CO 81089 <br />Phone Number: <br />(719) 738-6263 <br />Fax Number: <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 />0 <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -0 1 <br />