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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: Cj <br /> Email Address: <br /> Permitting Contact: Deaglag4 -Eonger-- <br /> Company: Geelogical Services <br /> Address: 71+Hartman Rd. ` � c <br /> Gode�;_C{ 4U2-1-4029 c}49 N is J i <br /> Phone Number: (970)565-8-394— <br /> Fax Number: Cr7n a q I <br /> I <br /> Email Address: <br /> `'L��a,r - � , � ��rs� cL��ti�► <br /> Inspection Contact: 94an-W.Wilson } <br /> Company: Montrose County <br /> Address: <br /> 2 <br /> Phone Number: -7755- <br /> Fax Number: <br /> Ss'G <br /> Email Address: <br /> V i IJ ck-% 1,104,i3 T ` 1.1 Z r f_f <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 D' 'sion approved mining and reclamation plans. <br /> 2 / <br /> Signatu a rmittee,Corporat ffi er,Owner,or Documented Designee D to <br /> M-AF-04 <br />