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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 />Kelly Kardos <br />Permittee Company: <br /> <br />XTO Energy Inc. <br />Address: <br /> <br /> <br /> <br />P.O. BOX 6501 <br />ENGLEWOOD, CO 80155 <br /> <br />Phone Number: <br /> <br />(303) 397-3727 <br />Fax Number: (505) 213-0456 <br />Email Address: Kelly_kardos@xtoenergy.com <br />Permitting Contact: <br /> <br />Kelly Small <br />Company: <br /> <br />XTO Energy Inc. <br />Address: <br /> <br /> <br /> <br />382 Road 3100 <br />Aztec, NM 87410 <br /> <br />Phone Number: <br /> <br /> <br />Fax Number: <br />Email Address: <br />Inspection Contact: <br /> <br />Kelly Small <br />Company: <br /> <br />XTO Energy Inc. <br />Address: <br /> <br /> <br /> <br />382 Road 3100 <br />Aztec, NM 87410 <br /> <br />Phone Number: <br /> <br /> <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