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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: Myron Mullett <br /> Permittee Company: Mullett Excavating, LLC <br /> Address: P.O. Box 322 <br /> Westcliffe, CO 81252 <br /> Phone Number: (719) 783-2056 <br /> Fax Number: (719) 783-0156 <br /> Email Address: <br /> Permitting Contact: Jee4gag4ano PZA4�rUkA- <br /> Company: —Be. <br /> Address: e ' e Pa RJ p 322 <br /> Phone Number: (5ff=��t24 <br /> Fax Number: P-9-}3S83-0-768 <br /> Email Address: MLLIje+fexD (Zn,N <br /> Inspection Contact: Myron Mullett <br /> Company: Mullett Excavating, LLC <br /> Address: P O Box 322 <br /> Westcliffe, CO 81252 <br /> Phone Number: (719) 783-2056 <br /> Fax Number: (719) 783-0156 <br /> Email Address: mw-116f ..ex CD�C,Lkjoo (enr\ <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 /> "o Alk�� I 11,2--11-�- <br /> Signa r ermittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF- <br />