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Page 5 of 5 <br /> <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: <br /> <br />James A. Davis <br />Permittee Company: <br /> <br />LaPlata County <br />Address: <br /> <br /> <br /> <br />1060 Main Avenue <br />Suite 104 <br />Durango, CO 81301 <br /> <br />Phone Number: <br /> <br />(970) 382-6363 <br />Fax Number: (970) 375-7986 <br />Email Address: Jim.davis@co.laplata.co.us <br />Permitting Contact: <br /> <br />Ed Bennett <br />Company: <br /> <br />La Plata County <br />Address: <br /> <br /> <br /> <br />26616 Highway 160 South <br />Durango, CO 81301 <br /> <br />Phone Number: <br /> <br />(970) 247-2617 <br />Fax Number: <br />Email Address: <br />Inspection Contact: <br /> <br />Ed Bennett <br />Company: <br /> <br />La Plata County <br />Address: <br /> <br /> <br /> <br />26616 Highway 160 South <br />Durango, CO 81301 <br /> <br />Phone Number: <br /> <br />(970) 247-2617 <br />Fax Number: <br />Email Address: <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br /> <br />M-AF-04