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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: Jim Davis <br /> Permittee Company: La Plata County <br /> Address: 1060 Main Ave., Unit 104 <br /> Durango, CO 81301 <br /> Phone Number: (970)382-6372 <br /> Fax Number: (970)375-7986 <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 /> bein ance with the Division approved mining and reclamation plans. <br /> c <br /> f to <br /> r <br /> Signature ermittee Cor ora Officer Owner,or Documented Designee e <br /> M-AF-( <br />