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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: Steve White <br /> Permittee Company: Montrose County <br /> Address: 949 N. 2nd Street <br /> Montrose, CO 81401 <br /> Phone Number: (970)249-6688 <br /> Fax Number: 7� c - <br /> Email Address: <br /> `i ; i2L'` 'L113 V A; / <br /> Permitting Contact: me'er- <br /> Company: Montrose County <br /> Address: Montrose County <br /> 'Montrose CO 81401 e�441 <br /> Phone Number: (q0)*ft44;93 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: "''kaud,R beAs- , <br /> Company: Montrose County <br /> Address: 32 S First S <br /> P.O. Bo, 89 <br /> Niomf6se, CO 81402 <br /> Phone Number: (970)249-6688 <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 condu d in accordance with the ivision approved mining and reclamation plans. <br /> I 11 I� <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />