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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: Russell Painter <br /> Permittee Company: Russell Painter <br /> Address: 1761 Pikes Peak Drive <br /> Florissant,CO 80816 <br /> Phone Number: - �C �^ `�, / <br /> Fax Number: <br /> Email Address: <br /> Permitting Contact: Russell Painter <br /> Company: Russell Painter <br /> Address: 1761 Pikes Peak Drive <br /> Florissant,CO 80816 <br /> Phone Number: 9}'S <br /> Fax Number: / So <br /> Email Address: <br /> Inspection Contact: Russell Painter <br /> Company: Russell Painter <br /> Address: 1761 Pikes Peak Drive <br /> Florissant,CO 80816 <br /> Phone Number: <br /> Fax Number: <br /> Email Address: D <br /> � <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 /> 11 Lz �C 22 /-V <br /> 1 -4 A f '-P�1 14 <br /> Signature ot Per ittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />