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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: ss <br /> �k N'e SS e 1Gl u F mac; � Z��►'►Nl.�rvt� <br /> Permittee Company: William& Beverly Caldwell and <br /> Albert& Lola Nesselhuf <br /> Address: 31738 County Road 13 p�Z <br /> f� CiDu,c.f-c� EC,� <br /> Manzanola, CO 81058 ��j�, � 9./D G7 <br /> Phone Number: (719)462-5236 t.o i a <br /> Fax Number: <br /> Email Address: <br /> n� I zf rnrh 3�n'l�� un�cl( e <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 Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-Af'-01 <br /> Le IY a b ��re55e-s '(f 0 <br /> i n <br /> 1 <br />