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: Robert Daugherty <br /> Permittee Company: Robert Daugherty <br /> Address: P.O. Box 1364 <br /> Clifton, CO 81520 <br /> Phone Number: (970)434-8773 <br /> Fax Number: (970)242-8438 <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 /> d '. -,J. <br /> ignatu e o P mittee or orate Officer,Owner,or Documented Designee D to <br /> M-AF-01 <br />