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Nov 01 16 09:06a Washington County 970-383-2213 p.2 <br /> 14^ ` q K3~o0l Page 5 of 5 <br /> Division records indicate the following pennittee contact infarmation. if this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Steve Williams <br /> MW <br /> Permittee Company: Washington County <br /> ny 0 1 01 <br /> Address: 150 Ash Avenue DIViSIUN tat kECLAMATION, <br /> MINING 8 -MINERALS <br /> Akron,CO 80720 PORT' WIF <br /> Phone Number: (970)383-2216 <br /> Pax Number: (970)383-2213 <br /> Email Address: r CCCt�5 �+t�,t— CC. <br /> I,the undersignecL 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 /> Signature of Permfte.Coriporate Offrcer,Owner,or Documealed Designee D e <br /> M-AF-04 <br />