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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: Randy Schafer <br /> Permittee Company: Phillips County <br /> Address: 221 S.Interocean Ave. <br /> Holyoke,CO 80734 <br /> Phone Number: (970) 854-3778 <br /> Fax Number: (970) 854-3811 <br /> Email Address: Randy.schafer@phillipscounty.co <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 /> (�?a �Id'04 IP// <br /> Signature of Per ee Cor rate Officer,Owner,or Documented Designee bate <br /> M-AF-04 <br />