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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: <br /> NArX 71'7,6(-k <br /> Permittee Company: Chaffee County <br /> Address: P.O.Box 699 <br /> Salida, CO 81201 <br /> Phone Number: (719)539-6961 <br /> Fax Number: (719)539-7442 <br /> Email Address: <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 /> Signat e o Cor s orate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />