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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: Tammie Crawford <br /> Permittee Company: Park County <br /> Address: P.O. Box 147 <br /> Fairplay, CO 80440 <br /> Phone Number: (719) 836-4283 <br /> Fax Number: (719)836-4275 <br /> Email Address: Trrawford@parkco.us <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 /> r 1 <br /> r- / //) 0 ,:::1 .L"—' 6 <br /> � <br /> Signa ure of Permittee, Corporate Officer, Owner r Documented Designee Da e <br /> M-AF-04 <br />