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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: George E. Otten <br /> Permittee Company: George E. Otten <br /> Address: 11438 CR 19 <br /> Fort Lupton, CO 80621 <br /> Phone Number: (970)785-2538 <br /> Fax Number: (970)785-6248 <br /> Email Address: Gotten7386@aol.com <br /> Permitting Contact: George E. Otten <br /> Company: George E. Otten <br /> Address: 7 S.<' t ��� ILittle 20 <br /> Foci l ur7o-N1 if J-V <br /> Phone Number: C(,(R/��Nr L97o 7js-.-� 3 <br /> Fax Number: ((, NTH 6770 7cS'S- -// <br /> Email Address: C"W e vj; G C1-7TEN 73c?6 C,,4D -, Co <br /> Inspection Contact: George E.Otten <br /> Company: George E. Otten <br /> Address: S. Elati -�( t�NT: //��� 19 <br /> L o f0 L 0 dG 6- <br /> Phone Number: ����gu ���a C_ldlQ ENy"" 70 7es, - 3--T <br /> Fax Number: Al <br /> Email Address: ` � ►r. GvrjcN <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 /> C,4c L ftAl <br /> Signature o ermittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />