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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: Patti Zictlow <br /> Pennittee Company. City of Colorado Springs <br /> Address: P.O. Box 1103 <br /> Mail Code 940 <br /> Colorado Springs,CO 80947 <br /> Phone Number: (719)6684171 <br /> Fax Number: (719)668-8666 <br /> Email Address: Pzietlow@csu.org <br /> csu.org <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 Car orate Officer Owner,or Documented Designee Date <br /> NUAIF-64 <br />