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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: Travis R.Crawford <br /> Permittee Company: Silver Mountain Preserve,Inc. <br /> Address: 11850 CR 520 <br /> La Veta,CO 81055 <br /> Phone Number: (719)742-3971 "7 1 <br /> Fax Number: (719)868-2416 _ 1 gg I <br /> t/ <br /> Email Address: Trrawford@crawfordbuickgmc.com <br /> Permitting Contact: Travis R.Crawford <br /> Company: Silver Mountain Preserve,Inc. <br /> Address: 11850 CR 520 <br /> La Veta,CO 81055 <br /> Phone Number: (719)34Wd1291 -77 g "7 7 F/ <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Travis R.Crawford G <br /> Company: Silver Mountain Preserve,Inc. <br /> Address: 11850 CR 520 <br /> La Veta,CO 81055 <br /> Phone Number: (719)33q-9-�44 C���r 7 78 7 7 / <br /> Fax Number: , _ > _ p <br /> Email Address: t�,2Aw �D� Rw o���y°c,LCtiMC <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 Cor ,orate icer,Owner,or Documented Designee Date <br /> M-AF-01 <br />