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Page 5 of S <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: Jean M.Cowman <br /> Permittee Company: Jean Marie Cowman <br /> Address: 1065 S. Woodland Ave.#1 <br /> Woodland Park,CO 80863 <br /> Phone Number: (719)314-8945 <br /> Fax Number: <br /> Email Address: Jeancowman@peakinter.net <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 /> e'e5t,(1)12-s--- deS'- 4 <br /> Signature of Permittee. rnorate Officer,Owner,or Documented DesiEnee Date <br /> M-AF-O <br />