Laserfiche WebLink
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: CF.PR.contact_first_name / <br /> CF.PR.contact last name <br /> Permittee Company: CF.PR.company_name / t <br /> Address: CF.PR.address_1 / ]� <br /> CF.PR.city, CF.PR.state <br /> CF.PR.zip_code <br /> Phone Number: CF.PR.telephone_number <br /> Fax Number: <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 conducted in accordance with the Division approved mining and reclamation plans. <br /> Signature of PermitYee,-Corporajf Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />