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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: Jack Howard <br /> Permittee Company: Kiowa County <br /> Address: P.O. Box 100 <br /> Eads, CO 81036 <br /> Phone Number: (719)438-5810 <br /> Fax Number: (719)438-5327 <br /> Email Address: <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 /> --//2 - <br /> Sign ure Permittee, Corporate Officer, Owner,or Documented Designee Date <br /> M-AF-04 <br />