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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: . mon <br /> Permittee Company: Washington County <br /> Address: 150 Ash Avenue <br /> Akron,CO 80720 <br /> Phone Number: (970)345-2337 <br /> Fax Number: (970)345-6593 <br /> Email Address: cODA 4,S_ 6-j;oncayap. <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 /> Si re 61AEjElffee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />