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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: Phil Dorenkamp <br /> Permittee Company: Las Animas County <br /> Address: 2000 N. Linden Ave. <br /> Trinidad,CO 81082 <br /> Phone Number: (719)846-2931 <br /> Fax Number: (719)846-0434 <br /> Email Address: Phil.doreankamp@lasanimascounty.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 /> &.1 ig. P-- -5 a6/ <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />