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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: Michael S.Davis <br /> Permittee Company: Dolores County <br /> Address: P.O.Box 608 <br /> Dove Creek, CO 81324 <br /> Phone Number: (970)677-2328 <br /> Fax Number: (970)677-3759 <br /> Email Address: Dcroad@centurytel.net <br /> Permitting Contact: Michael S.Davis <br /> Company: Dolores County <br /> Address: P.O. Box 608 <br /> Dove Creek,CO 81324 <br /> Phone Number: (970)677-2383 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Michael S.Davis <br /> Company: Dolores County <br /> Address: P.O.Box 608 <br /> Dove Creek,CO 81324 <br /> Phone Number: (970)677-2383 <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 /> Ibeing conducted in accordance with the Division approved mining and reclamation plans. <br /> .2 1 q /J'2j/ <br /> Signature o Permittee, raorate Officer,Owner,or Documented Designee date <br /> M-AF-04 <br />