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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: Melanie Bounds <br /> Permittee Company: Huerfano County <br /> Address: 401 Main Street, Suite 105 <br /> Walsenburg,CO 81089 <br /> Phone Number: (719)738-3000 <br /> Fax Number: (719)738-3996 <br /> Email Address: <br /> 1,th undersi ned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being ondu ed in accor nce with the Division approved mining and reclamation plans. <br /> cL <br /> Sig ure Permit, r rate Officer,Owner,or Documented Designee D to <br /> M-AF 04 <br />