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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: Sterling Rife <br /> Permittee Company: Fremont County <br /> Address: 1170 Red Canyon Road <br /> Canon City, CO 81212 <br /> Phone Number: (719)276-7430 <br /> Fax Number: (719)275-2120 <br /> Email Address: aline <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(�4"- � • 3--17 -tee <br /> Signature of Per ittee or orate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />