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Page 5 of 5 <br /> Division records indicate the following pem-ittee contact information. If this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Mark Dorenkamp <br /> Permittee Company: Prowers County <br /> Address: 109 E. Sherman St. <br /> Lamar, CO 81052 <br /> Phone Number: (719)336-5536 <br /> Fax Number: (719) 336-9633 <br /> Email Address: <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 therDivision approved mining and reclamation plans. <br /> Signature of Permittee, Co orate Officer, Owner.or Documented Designee Date <br /> M-AF-04 <br />