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 />Permittee Contact: <br />Keith Holsinger <br />Permittee Company: <br />Keith Holsinger <br />Address: <br />P.O. Box 37 <br />Walden, CO 80480 <br />Phone Number: <br />(970) 723-4587 <br />Fax Number: <br />(970) 723-4771 <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 ermittee, Corporate 0 er, Owner, or Documented Designee <br />M -AF -01 <br />3/7//6 <br />Date <br />