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Page 5 of 5 <br /> Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Melanie Bounds <br /> Permittee Company: Huerfano County <br /> Address: 401 Main St., Ste. 105 <br /> Walsenburg,CO 81089 <br /> Phone Number: (719) 738-3053 <br /> Fax Number: (719) 738-3996 <br /> Email Address: Mbounds@huerfano.us <br /> Permitting Contact: Melanie Bounds <br /> Company: Huerfano County <br /> Address: 401 Main St., Ste. 105 <br /> Walsenburg,CO 81089 <br /> Phone Number: (719) 738-3053 <br /> Fax Number: (719) 738-3996 <br /> Email Address: Mbounds@huerfano.us <br /> Inspection Contact: Drew Nigrini <br /> Company: Huerfano County <br /> Address: 401 Main St., Ste 201 <br /> Walsenburg, CO 81089 <br /> Phone Number: (719) 738-2370 <br /> Fax Number: (719) 738-3996 <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 onduc d in accorda�ice with the Division approved mining and reclamation plans. <br /> II <br /> VAF-04 <br /> ature Permitte orate Officer Owner or Documented Designee Date <br />