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: Lance Barker <br /> Permittee Company: Mineral Mountain Gold,LLC <br /> Address: P.O. Box 247 <br /> Cripple Creek, CO 80813 <br /> Phone Number: (719)689-5965 <br /> Fax Number: <br /> Email Address: / 6Q'((,t�� ���n �Yt <br /> I,the un ersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being ucted in acco ance w' h the Division approved mining and reclamation plans. <br /> V,'�j Id.11,1 <br /> )/v <br /> Sig ature of Permit4ee, Corporate Officer,Owner,or Documented Designee 4te <br /> M-AF-02 <br />