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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: Dean Ormiston <br /> Permittee Company: Baca County <br /> Address: 741 Main Street, Suite 1 <br /> Springfield, CO 81073 <br /> Phone Number: - 84 <br /> Fax Number: 71 <br /> Email Address: Dormiston@bacacountyco.gov - <br /> Or c �. <br /> I,the undersigned, hereby stajwithth <br /> fo ation provided in this report is true and accurate, and that site operations are <br /> being c e in ccordancvsion approved mining and reclamation plans. <br /> Signature of er ee Corer, Owne , ocumented Designee Date <br /> M-AF-04 <br />