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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: Rrn-Petersm <br /> A CKC' rS�'"1 1 T I�CC l�ct 1's C✓� <br /> Permittee Company: Carder, Inc. <br /> L,c. <br /> Address: Pf�-- X 2 I G `t X'Y �96 G <br /> r J06 ! I y Z L/ <br /> or�1�,► �� D r�....k, C r 6 <br /> Phone Number: ( -3bz — <br /> \k5- ;1(0-35's► 11 �i- 6 -) -3Ss <br /> Fax Number: (719) 336-0196 <br /> � —;2-6 -7- 3 So I <br /> Email Address: f C--� <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 /> 0� 10"�- ?/8//6 <br /> Signature of Permittee, Corporate Officer, Owner,or Documented Designee Date <br /> M-AF-01 <br />