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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: Calvin Feik <br /> Permittee Company: Bent County <br /> Address: P O Box 350 <br /> Las Animas,CO 81054 <br /> Phone Number: (719)456-2223 <br /> Fax Number: 61 9)K:w_03 <br /> Email Address: Bent.admin@bentcounty.net <br /> Permitting Contact: Calvin Feik <br /> Company: Bent County <br /> Address: P O Box 350 <br /> Las Animas, CO 81054 <br /> Phone Number: (719)456-2223 <br /> Fax Number: 71)ys6 0�r7-f <br /> Email Address: Bent.admin@bentcounty.net <br /> Inspection Contact: Calvin Feik <br /> Company: Bent County <br /> Address: P O Box 350 <br /> Las Animas, CO 81054 <br /> Phone Number: (719)456-2223 <br /> Fax Number: 61q) Ys6-p3 7 S / <br /> Email Address: Bent.admin@bentcounty.net '/ <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 /> e:f�' 2 6 /7 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />