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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: Lex Nichols <br /> Permittee Company: Otero County <br /> Address: 13 W. 3rd St.,Room 208 <br /> La Junta, CO 81050 <br /> Phone Number: (719)383-3035 <br /> Fax Number: <br /> Email Address: Lnichols@oterogov.org <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 /> It"ll -;�:/jO Z4 7 <br /> tvlo'—1 b <br /> Signature of Permittee,C rporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />