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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 6n record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Baxter Kirkland <br /> Permittee Company: Kirkland Construction,R.L.L.P. <br /> Address: P.O. Box 580 <br /> Rye,CO 81069 <br /> Phone Number: (719)489-3385 <br /> Fax Number: (719)489-2268 <br /> Email Address: <br /> Permitting Contact: Baxter Kirkland <br /> Company: Kirkland Construction,R.L.L.P. <br /> Address: P O Box 580 <br /> Rye, CO 81069 <br /> Phone Number: (719)489-3385 <br /> Fax Number: (719)489-2268 <br /> Email Address: <br /> Inspection Contact: Baxter Kirkland <br /> Company: Kirkland Construction,R.L.L.P. <br /> Address: P O Box 580 <br /> Rye,CO 81069 <br /> Phone Number: (719)489-3385 <br /> Fax Number: (719)489-2268 <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 /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> � d /�- ?/,7---///;7 <br /> Signature of Permittee Co orate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />