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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: John DeWitt <br /> Permittee Company: Lincoln County <br /> Address: P.O. Box 39 <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 <br /> Email Address: <br /> 1,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 the Division approved mining and reclamation plans. <br /> ^c <br /> 4 <br /> Signature a Permittee,Coraorate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />