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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: T.E.Allumbaugh <br /> Permittee Company: Crowley County <br /> Address: 603 Main St. Ste. 2 <br /> Ordway, CO 81063 <br /> Phone Number: (719)267-5555 <br /> Fax Number: (719)267-3114 <br /> Email Address: Tobe@crowleycounty.net <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being co ucted in accordance with the Division approved mining and reclamation plans. <br /> '11- ture of Permittee,Corporate Officer,Owner,or Doc mented Designee Date <br /> M-AF-04 <br />