Laserfiche WebLink
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: Daniel M.Russell <br /> /� rian S�P..1eV" <br /> Permittee Company: Daniel M Russell 11 <br /> 65meiev° �c�5�'cI i`t s C�rt;Zsuc � <br /> Address: 9042 S. 106 Rd. ,G ax rC 3 <br /> Alamosa,CO 81101 �QM1p 'r CO <br /> TO <br /> Phone Number: (719)587-3630 p, flZLI <br /> 7-7 <br /> Fax Number: (719)587-3632 91 / SS? —0( 75 <br /> Email Address: Surveyors@bresnan.net <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 ith the Division approved mining and reclamation plans. <br /> (�4L ( 7- / <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />