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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: LTs iulffahilt <br /> Sa►neilf- J1-,LjwL <br /> Permittee Company: Mineral County <br /> Address: P.O. Box 70 <br /> Creede,CO 81130 <br /> Phone Number: (719)658-2360 <br /> Fax Number: (719)658-2931 <br /> Email Address: m n C ® �o�rra I ,Co" <br /> 1,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 /> "L",L 5 t 2 I co <br /> Signature o ermittee Cor ora a Officer,Owner,or Documented Designee Date <br /> M-AY-04 <br />